Provider Demographics
NPI:1144228982
Name:KERNS, JENNIFER J (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:KERNS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PIRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:427 S BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2509
Mailing Address - Country:US
Mailing Address - Phone:509-456-0107
Mailing Address - Fax:509-747-2635
Practice Address - Street 1:427 S BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2509
Practice Address - Country:US
Practice Address - Phone:509-456-0107
Practice Address - Fax:509-747-2635
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010136152OtherASURIS(REGENCE BS OF ID)
ID1144228982OtherPUBLIC ASSISTANCE
WA8530PIOtherASURIS(REGENCE NW HEALTH)
WA0154324OtherLABOR AND INDUSTRIES
WA410046467OtherRAILROAD MEDICARE
WA1144228982Medicaid
WAA027OtherTRICARE
WAWA0690OtherNORTHWEST BENEFIT NETWORK
WA19560OtherGROUP HEALTH
WA910852217OtherTAX ID NUMBER
WAWA0690OtherNORTHWEST BENEFIT NETWORK
WA8530PIOtherASURIS(REGENCE NW HEALTH)