Provider Demographics
NPI:1114214921
Name:KERSEY-MCMULLEN, AYANNA S (DO, MSPH)
Entity Type:Individual
Prefix:DR
First Name:AYANNA
Middle Name:S
Last Name:KERSEY-MCMULLEN
Suffix:
Gender:F
Credentials:DO, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 SOUTH 5TH STREET
Mailing Address - Street 2:GOOD SHEPHERD REHABILITATION HOSPITAL
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 SOUTH 5TH STREET
Practice Address - Street 2:GOOD SHEPHERD REHABILITATION HOSPITAL
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-776-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017783208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation