Healthcare Provider Details

I. General information

NPI: 1205750890
Provider Name (Legal Business Name): DAVID ALLEN KERNS JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 HOWARD ST
NEW LONDON CT
06320-5544
US

IV. Provider business mailing address

94 GAIL DR
NAUGATUCK CT
06770-2124
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-7907
  • Fax: 860-865-2387
Mailing address:
  • Phone: 203-490-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23.007840
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: