Provider Demographics
NPI:1205097664
Name:KERNE, PHILIP ADOLPHE IV (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ADOLPHE
Last Name:KERNE
Suffix:IV
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 S IH 35
Mailing Address - Street 2:#732
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-2603
Mailing Address - Country:US
Mailing Address - Phone:512-382-5410
Mailing Address - Fax:
Practice Address - Street 1:10505 S IH 35
Practice Address - Street 2:#732
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-2603
Practice Address - Country:US
Practice Address - Phone:512-382-5410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33792103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical