1386012656 NPI number — MRS. EDDIE JEAN KERNEY PH.D.

Table of content: MRS. EDDIE JEAN KERNEY PH.D. (NPI 1386012656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386012656 NPI number — MRS. EDDIE JEAN KERNEY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERNEY
Provider First Name:
EDDIE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1386012656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 NORTH HIGH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-773-5559
Provider Business Mailing Address Fax Number:
740-774-4757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 HOPETOWN ROAD
Provider Second Line Business Practice Location Address:
THE DAVID ATER DYSLEXIA AND ADHD CLINIC;
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-773-2343
Provider Business Practice Location Address Fax Number:
740-774-4757
Provider Enumeration Date:
09/03/2015

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: 103TS0200X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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