Provider Demographics
NPI:1952542367
Name:KERNAHAN, REBECCA LYN (RSS)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYN
Last Name:KERNAHAN
Suffix:
Gender:F
Credentials:RSS
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:LYN
Other - Last Name:GENTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4400 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5108
Mailing Address - Country:US
Mailing Address - Phone:405-424-7711
Mailing Address - Fax:405-425-0445
Practice Address - Street 1:4400 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105
Practice Address - Country:US
Practice Address - Phone:405-424-7711
Practice Address - Fax:405-425-0445
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK144171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator