Provider Demographics
NPI:1528283058
Name:KERNER, WILLIAM EDWIN (MA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWIN
Last Name:KERNER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 E JERSETY ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-8704
Mailing Address - Country:US
Mailing Address - Phone:918-361-5319
Mailing Address - Fax:
Practice Address - Street 1:2134 E 61ST ST APT GG
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-0950
Practice Address - Country:US
Practice Address - Phone:918-743-8549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional