Provider Demographics
NPI:1215932348
Name:KERSHAW-MCLENNAN, JANET (MD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:KERSHAW-MCLENNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 MORRO RD
Mailing Address - Street 2:STE D
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3911
Mailing Address - Country:US
Mailing Address - Phone:805-466-7722
Mailing Address - Fax:805-461-1763
Practice Address - Street 1:8105 MORRO RD
Practice Address - Street 2:STE D
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3911
Practice Address - Country:US
Practice Address - Phone:805-466-7722
Practice Address - Fax:805-461-1763
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66499174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66499OtherBLUE CROSS PIN
CA00G664990OtherBLUE SHIELD PIN
CA00G664990Medicaid
CAF15195Medicare UPIN
CAG66499Medicare ID - Type Unspecified