Provider Demographics
NPI:1407303480
Name:KERNS FAMILY HEALTH CARE LLC
Entity Type:Organization
Organization Name:KERNS FAMILY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DANYELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:816-233-4967
Mailing Address - Street 1:1335 VILAGE DR B
Mailing Address - Street 2:
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2457
Mailing Address - Country:US
Mailing Address - Phone:816-233-7258
Mailing Address - Fax:816-233-4967
Practice Address - Street 1:1335 VILAGE DR B
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2457
Practice Address - Country:US
Practice Address - Phone:816-233-7258
Practice Address - Fax:816-233-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013010840261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF29A00059Medicare UPIN