Provider Demographics
NPI:1225407950
Name:KEARNS, CAROLE (LVN)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:KEARNS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6444
Mailing Address - Country:US
Mailing Address - Phone:916-289-9219
Mailing Address - Fax:
Practice Address - Street 1:3736 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6444
Practice Address - Country:US
Practice Address - Phone:916-289-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN278138164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse