Provider Demographics
NPI:1740945963
Name:KERNAN, RACHEL TERESA (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:TERESA
Last Name:KERNAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 BENNAVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7152
Mailing Address - Country:US
Mailing Address - Phone:614-288-4472
Mailing Address - Fax:
Practice Address - Street 1:60005 CAMPGROUND RD STE 600
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3447
Practice Address - Country:US
Practice Address - Phone:586-372-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant