Provider Demographics
NPI:1083982128
Name:KERNER, AMELIA SIANI (PA)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:SIANI
Last Name:KERNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:TERESA
Other - Last Name:SIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DH - CRITICAL CARE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-4642
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DH - CRITICAL CARE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-04
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002711363AM0700X
NH1005363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003027117Medicaid
CT003027117Medicaid
CTD400063430 - C00023Medicare PIN