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NPI Code Detail

MEDICARE: MRS. DIANNE LYNN KERSH MSW

MEDICARE: MRS. DIANNE LYNN KERSH MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorMSWPA

General Provider Information

NPI Number : 1326116351
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANNE LYNN KERSH MSW
Provider Business Mailing Address
First Line : 1110 EDGEWOOD AVE W
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32208-6405
Country : US
Telephone Number : 904-924-1550
Fax Number : 904-924-1544
Provider Business Practice Location Address
First Line : 1110 EDGEWOOD AVE W
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32208-6405
Country : US
Telephone Number : 904-924-1550
Fax Number : 904-924-1544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 07/08/2007

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