Provider Demographics
NPI:1083606438
Name:KEMMERLING, BEVERLY JEANNE (ANP-C)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JEANNE
Last Name:KEMMERLING
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 VALEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2865
Mailing Address - Country:US
Mailing Address - Phone:805-405-9883
Mailing Address - Fax:661-362-5051
Practice Address - Street 1:26455 ROCKWELL CANYON RD
Practice Address - Street 2:COC STUDENT HEALTH & WELLNESS CENTER
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-1803
Practice Address - Country:US
Practice Address - Phone:661-362-3259
Practice Address - Fax:661-362-5051
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN435904363LA2200X, 363LC1500X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMK1079830OtherDEA NUMBER