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General NPI Number Information
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NPI Number | 1932738853
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Entity Type | Individual
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Provider Name | DERRIK DAVID KERNS
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Gender | Male
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 1822 S 4TH ST
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City | AMES
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State | IA
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Zip | 50011-1142
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Country | US
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Telephone | 515-294-6721
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Fax |
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Provider Business Mailing Address
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Address Line | 203 N 3RD AVE
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City | ANTHON
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State | IA
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Zip | 51004-8179
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Country | US
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Telephone | 712-840-1513
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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