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General NPI Number Information
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NPI Number | 1497445183
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Entity Type | Individual
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Provider Name | JORDYN ASHLY KERNER
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Gender | Female
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 3130 INLAND EMPIRE BLVD STE B
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City | ONTARIO
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State | CA
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Zip | 91764-6570
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Country | US
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Telephone | 909-490-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 1908 POINT DE VUE DR
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City | FLOWER MOUND
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State | TX
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Zip | 75022-5594
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Country | US
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Telephone | 972-974-2628
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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 | 65204
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License Number State | CA
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