Provider Demographics
NPI:1356975940
Name:KERNER, MITCHELL (ANP)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:KERNER
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CARRIAGE DR APT 6
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1834
Mailing Address - Country:US
Mailing Address - Phone:716-860-0086
Mailing Address - Fax:
Practice Address - Street 1:100 COLLEGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6885
Practice Address - Country:US
Practice Address - Phone:716-631-8863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309551-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health