Provider Demographics
NPI:1427327204
Name:KERNAN, RENEE M (MS)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:M
Last Name:KERNAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2216
Mailing Address - Country:US
Mailing Address - Phone:518-884-7270
Mailing Address - Fax:518-884-7268
Practice Address - Street 1:100 WOOD RD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2216
Practice Address - Country:US
Practice Address - Phone:518-884-7270
Practice Address - Fax:518-884-7268
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1391517174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist