Provider Demographics
NPI:1396992780
Name:KERMODE, CHARLOTTE ANNE (APN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:ANNE
Last Name:KERMODE
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:ANNE
Other - Last Name:HARTZOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 HARVARD WAY # T5
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2055
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-4595
Practice Address - Street 1:13945 S VIRGINIA ST
Practice Address - Street 2:#632
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3900
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
11934135OtherCAQH