Provider Demographics
NPI:1033516240
Name:KERN, THERESA (MS,RN, AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:MS,RN, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1517
Mailing Address - Country:US
Mailing Address - Phone:937-293-5662
Mailing Address - Fax:937-258-5478
Practice Address - Street 1:324 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1890
Practice Address - Country:US
Practice Address - Phone:937-256-4490
Practice Address - Fax:937-258-5478
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17591207QH0002X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine