Provider Demographics
NPI:1275243404
Name:MCKERNAN, RACHEL ANNE (PAC, MPAS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:MCKERNAN
Suffix:
Gender:F
Credentials:PAC, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7970 MENTOR AVE APT D4
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5602
Mailing Address - Country:US
Mailing Address - Phone:724-553-4831
Mailing Address - Fax:
Practice Address - Street 1:5800 LANDERBROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-6510
Practice Address - Country:US
Practice Address - Phone:440-443-0438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007842RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant