Provider Demographics
NPI:1194713701
Name:KERN, JEFFERY JUSTIN (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:JUSTIN
Last Name:KERN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843013
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3013
Mailing Address - Country:US
Mailing Address - Phone:910-895-1989
Mailing Address - Fax:910-895-9666
Practice Address - Street 1:104 PHYSICIANS PARK DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-5204
Practice Address - Country:US
Practice Address - Phone:910-895-1989
Practice Address - Fax:910-895-9666
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2014-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC103521363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC103521OtherSTATE LICENSE
NC103521OtherSTATE LICENSE
970028080 RAILROADMedicare PIN
NCP67607Medicare UPIN