Healthcare Provider Details

I. General information

NPI: 1326178880
Provider Name (Legal Business Name): JENNIFER M KERN DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3227 SUNSET BLVD # D STE 101
WEST COLUMBIA SC
29169-3201
US

IV. Provider business mailing address

3227 SUNSET BLVD # D STE 101
WEST COLUMBIA SC
29169-3201
US

V. Phone/Fax

Practice location:
  • Phone: 803-926-8039
  • Fax: 803-926-3414
Mailing address:
  • Phone: 803-926-8039
  • Fax: 803-926-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00119
License Number StateSC

VIII. Authorized Official

Name: JENNIFER M KERN
Title or Position: PRESIDENT
Credential: DPM
Phone: 803-926-0039