Healthcare Provider Details

I. General information

NPI: 1265271274
Provider Name (Legal Business Name): KATELYN RENE KERNS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 BANYON DR
BEAVERCREEK OH
45431-2612
US

IV. Provider business mailing address

2424 BANYON DR
BEAVERCREEK OH
45431-2612
US

V. Phone/Fax

Practice location:
  • Phone: 937-266-9711
  • Fax:
Mailing address:
  • Phone: 937-266-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042784
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.474230
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: