Provider Demographics
NPI:1508142019
Name:KERNEN, SHARON JANICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:JANICE
Last Name:KERNEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 GALAXIA WAY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1440
Mailing Address - Country:US
Mailing Address - Phone:505-263-8055
Mailing Address - Fax:505-821-8775
Practice Address - Street 1:9001 GALAXIA WAY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1440
Practice Address - Country:US
Practice Address - Phone:505-263-8055
Practice Address - Fax:505-821-8775
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1130103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist