Provider Demographics
NPI:1821259391
Name:KERN, SHAUNA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:MARIE
Last Name:KERN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:KS
Mailing Address - Zip Code:67063-1530
Mailing Address - Country:US
Mailing Address - Phone:620-947-1421
Mailing Address - Fax:
Practice Address - Street 1:704 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:KS
Practice Address - Zip Code:67063-1530
Practice Address - Country:US
Practice Address - Phone:620-947-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0534761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200689800CMedicaid
KS003719094Medicare Oscar/Certification