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General NPI Number Information
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NPI Number | 1003792532
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Entity Type | Individual
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Provider Name | LARRY EUGENE KERTNER PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 5200 HARRY HINES BLVD. WISH BUILDING, 3RD. FLOOR, 03-113, SECOND DOOR
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City | DALLAS
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State | TX
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Zip | 75235
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Country | US
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Telephone | 469-419-2323
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Fax | 214-590-2489
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Provider Business Mailing Address
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Address Line | 5200 HARRY HINES BLVD. WISH BUILDING, 3RD. FLOOR, 03-113, SECOND DOOR
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City | DALLAS
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State | TX
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Zip | 75235
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Country | US
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Telephone | 469-419-2323
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Fax | 214-590-2489
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1208274
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License Number State | TX
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