Healthcare Provider Details

I. General information

NPI: 1659608982
Provider Name (Legal Business Name): FERNAN FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S. MILL ST.
RIDGWAY PA
15853
US

IV. Provider business mailing address

200 S. MILL ST.
RIDGWAY PA
15853
US

V. Phone/Fax

Practice location:
  • Phone: 814-772-0722
  • Fax: 814-772-6934
Mailing address:
  • Phone: 814-772-0722
  • Fax: 814-772-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS013170
License Number StatePA

VIII. Authorized Official

Name: DR. KATHLEE M FERNAN
Title or Position: OWNER
Credential: D.O.
Phone: 814-772-0722