Provider Demographics
NPI:1891344297
Name:KERNODLE, TRISHA A (APRN)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:A
Last Name:KERNODLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 COMPASSION CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1645
Mailing Address - Country:US
Mailing Address - Phone:907-212-9100
Mailing Address - Fax:
Practice Address - Street 1:910 COMPASSION CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1645
Practice Address - Country:US
Practice Address - Phone:907-212-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000234759163W00000X
TN26551363LF0000X
AK161675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty