Healthcare Provider Details

I. General information

NPI: 1225961816
Provider Name (Legal Business Name): CHRISTA B KERNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 W MAIN ST
WATERFORD WI
53185-4025
US

IV. Provider business mailing address

819 W MAIN ST
WATERFORD WI
53185-4025
US

V. Phone/Fax

Practice location:
  • Phone: 262-514-8200
  • Fax:
Mailing address:
  • Phone: 262-514-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number255460-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: