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General NPI Number Information
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NPI Number | 1205557006
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Entity Type | Individual
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Provider Name | KERONNE ALEXIS DNP,MSN,APRN,FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 555 MARIN ST
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-4236
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Country | US
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Telephone | 689-221-2774
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Fax |
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Provider Business Mailing Address
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Address Line | 555 MARIN ST
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-4236
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Country | US
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Telephone | 689-221-2774
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 950330132
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License Number State | CA
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