Provider Demographics
NPI:1841301033
Name:KERNER, CHERYL ROSE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ROSE
Last Name:KERNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:ROSE
Other - Last Name:MARQUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:83 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1626
Mailing Address - Country:US
Mailing Address - Phone:607-749-2497
Mailing Address - Fax:
Practice Address - Street 1:110 HO PLAZA
Practice Address - Street 2:GANNETT HEALTH SERVICES
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14853
Practice Address - Country:US
Practice Address - Phone:607-255-6106
Practice Address - Fax:607-254-3503
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400986-1363LP0808X
NYF334897-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007151Medicare ID - Type Unspecified
PA07363564-01OtherMEDICAL ASSISTANCE