Healthcare Provider Details

I. General information

NPI: 1992391924
Provider Name (Legal Business Name): MATTISON BAILEY KERNEA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 06/21/2024
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVENUE SOUTH 512 LOWDER
BIRMINGHAM AL
35233
US

IV. Provider business mailing address

1600 7TH AVENUE SOUTH 512 LOWDER
BIRMINGHAM AL
35233
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-5192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD.48750
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: