Healthcare Provider Details

I. General information

NPI: 1255412839
Provider Name (Legal Business Name): JOHN B KERNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 N LOVINGTON HWY STE 13
HOBBS NM
88240-9135
US

IV. Provider business mailing address

5419 N LOVINGTON HWY STE 13
HOBBS NM
88240-9135
US

V. Phone/Fax

Practice location:
  • Phone: 505-392-7798
  • Fax: 505-392-4926
Mailing address:
  • Phone: 505-392-7798
  • Fax: 505-392-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number78-47
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number78-47
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: