Healthcare Provider Details

I. General information

NPI: 1821067182
Provider Name (Legal Business Name): ELIZABETH MARIE KERN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 REILLY ROAD MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER
FT. BRAGG NC
28310
US

IV. Provider business mailing address

2817 REILLY ROAD MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER
FT. BRAGG NC
28310
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8922
  • Fax: 910-907-6060
Mailing address:
  • Phone: 910-907-8922
  • Fax: 910-907-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103705
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: