Provider Demographics
NPI:1942808357
Name:KERN, JEFFREY LYNN JR
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LYNN
Last Name:KERN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 WILLOW ST RENO NV 89502
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5033
Mailing Address - Country:US
Mailing Address - Phone:775-501-8655
Mailing Address - Fax:
Practice Address - Street 1:888 WILLOW ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1304
Practice Address - Country:US
Practice Address - Phone:775-384-1129
Practice Address - Fax:775-300-7068
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTIC-1631101YM0800X
NV8842-S104100000X
NVIC-16311041C0700X
NV10314-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker