Provider Demographics
NPI:1013331875
Name:KERNS, HOLLY N (LGSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:N
Last Name:KERNS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PRESTERA WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2069
Mailing Address - Country:US
Mailing Address - Phone:304-525-7851
Mailing Address - Fax:304-399-3700
Practice Address - Street 1:1 PRESTERA WAY
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2069
Practice Address - Country:US
Practice Address - Phone:304-525-7851
Practice Address - Fax:304-399-1202
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009443371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005355002Medicaid
WV9122432Medicare Oscar/Certification