Healthcare Provider Details

I. General information

NPI: 1154372100
Provider Name (Legal Business Name): SUSAN F KERNS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SE 17TH ST 600
OCALA FL
34471-4621
US

IV. Provider business mailing address

1500 SE 17TH ST 600
OCALA FL
34471-4621
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-8955
  • Fax: 352-732-7999
Mailing address:
  • Phone: 352-732-8955
  • Fax: 352-732-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME0059628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: