Provider Demographics
NPI:1932738853
Name:KERNS, DERRIK DAVID
Entity Type:Individual
Prefix:
First Name:DERRIK
Middle Name:DAVID
Last Name:KERNS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANTHON
Mailing Address - State:IA
Mailing Address - Zip Code:51004-8179
Mailing Address - Country:US
Mailing Address - Phone:712-840-1513
Mailing Address - Fax:
Practice Address - Street 1:1822 S 4TH ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011-1142
Practice Address - Country:US
Practice Address - Phone:515-294-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer