Healthcare Provider Details

I. General information

NPI: 1043191919
Provider Name (Legal Business Name): CATHERINE A KERNS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 N WASHINGTON ST
CHILLICOTHEE MO
64601-2902
US

IV. Provider business mailing address

801 BROOKFIELD AVE
BROOKFIELD MO
64628-1210
US

V. Phone/Fax

Practice location:
  • Phone: 660-646-2682
  • Fax:
Mailing address:
  • Phone: 660-646-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025026905
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025026905
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: