Healthcare Provider Details

I. General information

NPI: 1568402790
Provider Name (Legal Business Name): JENNIFER M KERN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
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: 803-926-0039
  • Fax: 803-926-3414
Mailing address:
  • Phone: 803-926-0039
  • 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:
Title or Position:
Credential:
Phone: