MEDICARE: DANYELLE DAWN KERNS NP-C

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
1	363LF0000X	Family Nurse Practitioner	2013010840	MO
2	207Q00000X	Family Medicine Physician	2013010840	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669805818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANYELLE DAWN KERNS NP-C

Provider Business Mailing Address
First Line	:	220 S WOODBINE RD
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3447
Country	:	US
Telephone Number	:	816-676-1300
Fax Number	:	816-676-1400

Provider Business Practice Location Address
First Line	:	220 S WOODBINE RD
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3447
Country	:	US
Telephone Number	:	816-676-1300
Fax Number	:	816-676-1400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	10/11/2018

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