Provider Demographics
NPI:1043734072
Name:KERSHNER, STEPHANIE RAY (RRT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAY
Last Name:KERSHNER
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 DISTRIBUTION AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2742
Mailing Address - Country:US
Mailing Address - Phone:904-387-4481
Mailing Address - Fax:904-389-6965
Practice Address - Street 1:6851 DISTRIBUTION AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-387-4481
Practice Address - Fax:904-389-6965
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT16115227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered