Provider Demographics
NPI:1528879608
Name:KERNAGHAN, TERRA (LMT)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:KERNAGHAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 PULLEN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2529
Mailing Address - Country:US
Mailing Address - Phone:904-383-5823
Mailing Address - Fax:
Practice Address - Street 1:4540 SOUTHSIDE BLVD STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5488
Practice Address - Country:US
Practice Address - Phone:904-296-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA103110225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist