Provider Demographics
NPI:1265271274
Name:KERNS, KATELYN RENE (RN)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:RENE
Last Name:KERNS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 BANYON DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2612
Mailing Address - Country:US
Mailing Address - Phone:937-266-9711
Mailing Address - Fax:
Practice Address - Street 1:2424 BANYON DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2612
Practice Address - Country:US
Practice Address - Phone:937-266-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.474230163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse