Healthcare Provider Details

I. General information

NPI: 1902465644
Provider Name (Legal Business Name): JUNE KERN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 N BUTLER ST
LAS VEGAS NV
89129-4864
US

IV. Provider business mailing address

4125 N BUTLER ST
LAS VEGAS NV
89129-4864
US

V. Phone/Fax

Practice location:
  • Phone: 702-655-5557
  • Fax: 702-655-2743
Mailing address:
  • Phone: 702-655-5557
  • Fax: 702-655-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number4937AGC11
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number6083AGC6
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number59AGC22
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: