Healthcare Provider Details

I. General information

NPI: 1669844650
Provider Name (Legal Business Name): KERN MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 PEGASUS DR
BAKERSFIELD CA
93308-6807
US

IV. Provider business mailing address

2520 PEGASUS DR
BAKERSFIELD CA
93308-6807
US

V. Phone/Fax

Practice location:
  • Phone: 661-393-4877
  • Fax: 661-393-7339
Mailing address:
  • Phone: 661-393-4877
  • Fax: 661-393-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACY MARIE HUGHES
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 661-393-4877