Provider Demographics
NPI:1538475744
Name:KERN, CORY JEROME (PA-C)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:JEROME
Last Name:KERN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1479
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-1479
Mailing Address - Country:US
Mailing Address - Phone:817-596-3700
Mailing Address - Fax:866-883-0041
Practice Address - Street 1:2111 FORT WORTH HWY
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4834
Practice Address - Country:US
Practice Address - Phone:817-596-3700
Practice Address - Fax:866-883-0041
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06773363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical