Provider Demographics
NPI:1043719172
Name:KERN, MEG LENNETTE (PCA)
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:LENNETTE
Last Name:KERN
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:MRS
Other - First Name:MEG
Other - Middle Name:LENNETTE
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4850 W FLAMINGO RD STE 25
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3707
Mailing Address - Country:US
Mailing Address - Phone:702-871-9917
Mailing Address - Fax:702-871-9918
Practice Address - Street 1:4850 W FLAMINGO RD STE 25
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3707
Practice Address - Country:US
Practice Address - Phone:702-871-9917
Practice Address - Fax:702-871-9918
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health