Provider Demographics
NPI:1821656315
Name:JENNIFER ANN KERN PLLC
Entity Type:Organization
Organization Name:JENNIFER ANN KERN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:928-846-5824
Mailing Address - Street 1:3880 N STOCKTON HILL RD STE 103-443
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0595
Mailing Address - Country:US
Mailing Address - Phone:928-846-5824
Mailing Address - Fax:
Practice Address - Street 1:3880 N STOCKTON HILL RD STE 103-443
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0595
Practice Address - Country:US
Practice Address - Phone:928-846-5824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care