Provider Demographics
NPI:1437487931
Name:KERNAN, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:KERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1705
Mailing Address - Country:US
Mailing Address - Phone:573-756-0555
Mailing Address - Fax:573-756-0556
Practice Address - Street 1:202 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1705
Practice Address - Country:US
Practice Address - Phone:573-756-0555
Practice Address - Fax:573-756-0556
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009008392237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist