Provider Demographics
NPI:1487255915
Name:KERNS, CHRISTINE KATRINA
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KATRINA
Last Name:KERNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 SANDY HOLLOW RD.
Mailing Address - Street 2:
Mailing Address - City:BLOOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:26817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1841 SANDY HOLLOW RD.
Practice Address - Street 2:
Practice Address - City:BLOOMERY
Practice Address - State:WV
Practice Address - Zip Code:26817-2681
Practice Address - Country:US
Practice Address - Phone:304-851-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant