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General NPI Number Information
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NPI Number | 1235733627
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Entity Type | Individual
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Provider Name | AMY MARIE KERNS PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 469 EMILY DR
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City | CLARKSBURG
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State | WV
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Zip | 26301-5512
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Country | US
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Telephone | 304-423-5180
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Fax |
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Provider Business Mailing Address
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Address Line | 469 EMILY DR
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City | CLARKSBURG
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State | WV
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Zip | 26301-5512
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Country | US
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Telephone | 304-423-5180
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2443
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 845
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License Number State | WV
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