Provider Demographics
NPI:1518262955
Name:KERN, STEPFANIE JO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPFANIE
Middle Name:JO
Last Name:KERN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPFANIE
Other - Middle Name:JO
Other - Last Name:BENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:800-243-1455
Practice Address - Fax:717-531-4970
Is Sole Proprietor?:No
Enumeration Date:2011-01-16
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061754363A00000X
VA0110003503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518262955Medicaid
VAC06141Medicare PIN