Provider Demographics
NPI:1972880946
Name:KERNAL, JEAN L (CNS-AD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:KERNAL
Suffix:
Gender:F
Credentials:CNS-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 8TH AVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4124
Mailing Address - Country:US
Mailing Address - Phone:817-922-4675
Mailing Address - Fax:817-922-4645
Practice Address - Street 1:1250 8TH AVE
Practice Address - Street 2:SUITE 515
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4124
Practice Address - Country:US
Practice Address - Phone:817-922-4675
Practice Address - Fax:817-922-4645
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX748256364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286848101Medicaid
TX286848102Medicaid
TX298317YKTPMedicare PIN
TX286848102Medicaid
TXP01198074Medicare PIN