Provider Demographics
NPI:1891932752
Name:KERSHNAR, REBECCA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:KERSHNAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-0841
Mailing Address - Country:US
Mailing Address - Phone:831-768-0972
Mailing Address - Fax:
Practice Address - Street 1:550 S GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3053
Practice Address - Country:US
Practice Address - Phone:831-458-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine