1235143330 NPI number — PAMELA KERNS APRN

Table of content: PAMELA KERNS APRN (NPI 1235143330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235143330 NPI number — PAMELA KERNS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERNS
Provider First Name:
PAMELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235143330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 256
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67402-0256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-823-0633
Provider Business Mailing Address Fax Number:
785-823-0685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-8778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-283-1141
Provider Business Practice Location Address Fax Number:
316-283-1162
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  45365 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100430400I , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com