Provider Demographics
NPI:1568402790
Name:KERN, JENNIFER M (DPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:KERN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3227 SUNSET BLVD # D
Mailing Address - Street 2:STE 101
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3201
Mailing Address - Country:US
Mailing Address - Phone:803-926-0039
Mailing Address - Fax:803-926-3414
Practice Address - Street 1:3227 SUNSET BLVD # D
Practice Address - Street 2:STE 101
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3201
Practice Address - Country:US
Practice Address - Phone:803-926-0039
Practice Address - Fax:803-926-3414
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00119213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT95455Medicare UPIN
SC4213370001Medicare NSC
SCT954554772Medicare PIN