Healthcare Provider Details

I. General information

NPI: 1285686535
Provider Name (Legal Business Name): KIRK JAMES KERN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 OAK AVE
HARAHAN LA
70123
US

IV. Provider business mailing address

490 OAK AVE
HARAHAN LA
70123
US

V. Phone/Fax

Practice location:
  • Phone: 504-909-2970
  • Fax: 504-738-2711
Mailing address:
  • Phone: 504-738-0679
  • Fax: 504-738-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT754
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: