Provider Demographics
NPI:1881821593
Name:KERNS, JEANNETTE R (AP, DOM, LAC)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:R
Last Name:KERNS
Suffix:
Gender:F
Credentials:AP, DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 17TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4939
Mailing Address - Country:US
Mailing Address - Phone:407-738-7412
Mailing Address - Fax:321-340-3522
Practice Address - Street 1:2801 17TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4939
Practice Address - Country:US
Practice Address - Phone:407-738-7412
Practice Address - Fax:321-340-3522
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52174225700000X
FLAP3178171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102479200Medicaid