Provider Demographics
NPI:1992113906
Name:KERN, JENNIFER ANN (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:KERN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 GOLDEN GATE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4055
Mailing Address - Country:US
Mailing Address - Phone:928-529-5349
Mailing Address - Fax:928-529-5352
Practice Address - Street 1:1858 GOLDEN GATE AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4055
Practice Address - Country:US
Practice Address - Phone:928-529-5349
Practice Address - Fax:928-529-5352
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN169351364SF0001X
AZAP7314364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN169351OtherAZ LICENSE
AZAP7314OtherADV NURSE PRACTITIONER