Healthcare Provider Details

I. General information

NPI: 1013552637
Provider Name (Legal Business Name): CARRIE LEIGH KERN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE LEIGH JOHNSON

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2660
US

IV. Provider business mailing address

2100 SW 119TH ST
OKLAHOMA CITY OK
73170-3437
US

V. Phone/Fax

Practice location:
  • Phone: 505-207-3421
  • Fax: 505-702-8171
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142648
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-73109
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201995
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: