Provider Demographics
NPI:1982937421
Name:KERNS, SANDRA EB (RPA-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:EB
Last Name:KERNS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SEMMEL RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9784
Mailing Address - Country:US
Mailing Address - Phone:585-624-1532
Mailing Address - Fax:
Practice Address - Street 1:204 SEMMEL RD
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-9784
Practice Address - Country:US
Practice Address - Phone:585-624-1532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001065363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical