Healthcare Provider Details

I. General information

NPI: 1699451831
Provider Name (Legal Business Name): MCKENNA J KERSCHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENNA J JENSEN

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COUNTY ROAD B
SHAWANO WI
54166-7072
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 715-526-2111
  • Fax:
Mailing address:
  • Phone: 920-830-5900
  • Fax: 920-830-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8410-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: