Provider Demographics
NPI:1033004148
Name:KERNS, SHANNON KAYE (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:KAYE
Last Name:KERNS
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 W 625 S
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-1967
Mailing Address - Country:US
Mailing Address - Phone:435-559-2822
Mailing Address - Fax:
Practice Address - Street 1:1327 S INTERSTATE DR STE B
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-1258
Practice Address - Country:US
Practice Address - Phone:435-559-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9791808-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner