Healthcare Provider Details

I. General information

NPI: 1053342956
Provider Name (Legal Business Name): REBECCA L. GERNON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 E FRONTAGE RD SUITE 100
SHAWNEE MISSION KS
66204-1654
US

IV. Provider business mailing address

15977 COLLECTION CENTER DR
CHICAGO IL
60693-0159
US

V. Phone/Fax

Practice location:
  • Phone: 913-789-1940
  • Fax: 913-384-4093
Mailing address:
  • Phone: 800-737-5654
  • Fax: 423-855-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-31472
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: