Provider Demographics
NPI:1982646212
Name:FERNANDO, JASENTHU L
Entity Type:Individual
Prefix:DR
First Name:JASENTHU
Middle Name:L
Last Name:FERNANDO
Suffix:
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 1:923 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2429
Mailing Address - Country:US
Mailing Address - Phone:620-285-3161
Mailing Address - Fax:
Practice Address - Street 1:923 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-2429
Practice Address - Country:US
Practice Address - Phone:620-285-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04216832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY105219Medicare ID - Type Unspecified