MEDICARE: MRS. NANCY K KERNE LCSW

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	1041C0700X	Clinical Social Worker	1772	LA
2	101YM0800X	Mental Health Counselor	1772	LA

General Provider Information

NPI Number	:	1750317848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY K KERNE LCSW

Provider Business Mailing Address
First Line	:	4643 LINDELL BLVD APT 523
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3731
Country	:	US
Telephone Number	:	314-952-8819
Fax Number	:	314-361-6649

Provider Business Practice Location Address
First Line	:	4507 LACLEDE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108
Country	:	US
Telephone Number	:	314-952-8819
Fax Number	:	314-361-6649

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	08/26/2018

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