Provider Demographics
NPI:1225296684
Name:KERNS, DAWN JULAYNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:JULAYNE
Last Name:KERNS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 SW HAMPTON ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8329
Mailing Address - Country:US
Mailing Address - Phone:503-839-6155
Mailing Address - Fax:
Practice Address - Street 1:6950 SW HAMPTON ST
Practice Address - Street 2:SUITE #103
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8329
Practice Address - Country:US
Practice Address - Phone:503-839-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-01
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14582171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor