Provider Demographics
NPI:1598213456
Name:KERN, TINA (LPN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALVORDTON
Mailing Address - State:OH
Mailing Address - Zip Code:43501-9763
Mailing Address - Country:US
Mailing Address - Phone:419-924-2029
Mailing Address - Fax:
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALVORDTON
Practice Address - State:OH
Practice Address - Zip Code:43501-9763
Practice Address - Country:US
Practice Address - Phone:419-924-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.096228.MEDS-IV164W00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251S00000XAgenciesCommunity/Behavioral Health