Provider Demographics
NPI:1205303617
Name:KEARNS, SEAN PATRICK
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:KEARNS
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 1:1980 HORAL ST APT 1218
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-3939
Mailing Address - Country:US
Mailing Address - Phone:530-209-3759
Mailing Address - Fax:
Practice Address - Street 1:1980 HORAL ST APT 1218
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-3939
Practice Address - Country:US
Practice Address - Phone:530-209-3759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians