Healthcare Provider Details

I. General information

NPI: 1639889868
Provider Name (Legal Business Name): CASSANDRA LYNN MCKERNAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 AUBURN ROAD STE. 301
CONCORD TOWNSHIP OH
44077-9619
US

IV. Provider business mailing address

2000 AUBURN DR. STE.350
BEACHWOOD OH
44122-4327
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-7546
  • Fax: 440-352-5260
Mailing address:
  • Phone: 440-646-1600
  • Fax: 440-646-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1199527
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007843RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: