Healthcare Provider Details

I. General information

NPI: 1508142019
Provider Name (Legal Business Name): SHARON JANICE KERNEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 GALAXIA WAY NE
ALBUQUERQUE NM
87111-1440
US

IV. Provider business mailing address

9001 GALAXIA WAY NE
ALBUQUERQUE NM
87111-1440
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-8055
  • Fax: 505-821-8775
Mailing address:
  • Phone: 505-263-8055
  • Fax: 505-821-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1130
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: