Provider Demographics
NPI:1356609184
Name:KERN, LARISSA BRIERE (MD)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:BRIERE
Last Name:KERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:KERN
Other - Last Name:HUFNAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:202 BEVINS LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-6178
Mailing Address - Country:US
Mailing Address - Phone:859-323-9333
Mailing Address - Fax:
Practice Address - Street 1:202 BEVINS LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6178
Practice Address - Country:US
Practice Address - Phone:859-323-9333
Practice Address - Fax:502-570-5063
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48082207Q00000X
KYR3100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine