Provider Demographics
NPI:1558679845
Name:KERNOHAN, DEBORAH ANN (NP-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:KERNOHAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2546
Mailing Address - Country:US
Mailing Address - Phone:434-315-2890
Mailing Address - Fax:434-392-0333
Practice Address - Street 1:1530 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2546
Practice Address - Country:US
Practice Address - Phone:434-315-2890
Practice Address - Fax:434-392-0333
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11704-NP363LA2200X
OHRN 191533 COA-1363LA2200X
VA0024172598363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3106516Medicaid