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General NPI Number Information
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NPI Number | 1356693709
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Entity Type | Organization
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Legal Business Name | EAST LAKE ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 819 E OAK ST STE B
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City | KISSIMMEE
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State | FL
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Zip | 34744-5842
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Country | US
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Telephone | 407-738-7412
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Fax | 321-250-7841
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Provider Business Mailing Address
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Address Line | PO BOX 700215
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City | SAINT CLOUD
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State | FL
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Zip | 34770-0215
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Country | US
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Telephone | 407-738-7412
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Fax | 321-250-7841
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEANNETTE R KERNS
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Credential | AP, DOM, L.AC.
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Telephone | 407-738-7412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP 3178
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License Number State | FL
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