Healthcare Provider Details

I. General information

NPI: 1881821593
Provider Name (Legal Business Name): JEANNETTE R KERNS AP, DOM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 E OAK ST STE B
KISSIMMEE FL
34744-5842
US

IV. Provider business mailing address

PO BOX 700215
SAINT CLOUD FL
34770-0215
US

V. Phone/Fax

Practice location:
  • Phone: 407-738-7412
  • Fax: 321-340-3522
Mailing address:
  • Phone: 407-738-7412
  • Fax: 321-340-3522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3178
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA32174
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: