Provider Demographics
NPI:1598366155
Name:KERN, JOHN PETER III (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PETER
Last Name:KERN
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9063 CLEVELAND CT APT 102
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-0023
Mailing Address - Country:US
Mailing Address - Phone:847-609-7829
Mailing Address - Fax:
Practice Address - Street 1:11275 DELAWARE PKWY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7812
Practice Address - Country:US
Practice Address - Phone:219-779-8735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant