Provider Demographics
NPI:1245226034
Name:KERN, NANCY J (EDD, MSN, FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:KERN
Suffix:
Gender:F
Credentials:EDD, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3605 NORTHGATE CT
Practice Address - Street 2:SUITE 110
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6400
Practice Address - Country:US
Practice Address - Phone:812-949-5749
Practice Address - Fax:812-949-5794
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000158A363LF0000X, 207P00000X
KY3002127363LF0000X
IN71000158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78015237Medicaid
KY78015237Medicaid
S62182Medicare UPIN