Provider Demographics
NPI:1326178880
Name:JENNIFER M KERN DPM PA
Entity Type:Organization
Organization Name:JENNIFER M KERN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:803-926-0039
Mailing Address - Street 1:3227 SUNSET BLVD # D
Mailing Address - Street 2:STE 101
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3201
Mailing Address - Country:US
Mailing Address - Phone:803-926-8039
Mailing Address - Fax:803-926-3414
Practice Address - Street 1:3227 SUNSET BLVD # D
Practice Address - Street 2:STE 101
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3201
Practice Address - Country:US
Practice Address - Phone:803-926-8039
Practice Address - Fax:803-926-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00119213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1335704OtherCIGNA
SC4213370001Medicare NSC
SC480017552Medicare UPIN
SCT954554772Medicare PIN
SC1335704OtherCIGNA