MEDICARE: MATTHEW KERN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP134169	TX

General Provider Information

NPI Number	:	1225558307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW KERN FNP-C

Provider Business Mailing Address
First Line	:	703 S VERNE ST
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-4615
Country	:	US
Telephone Number	:	210-413-9734
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 NORTHSHORE BLVD
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-4206
Country	:	US
Telephone Number	:	361-480-0334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	06/21/2017

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