MEDICARE: ANGELA DAWN KERNS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	APS.003984	OH

General Provider Information

NPI Number	:	1356026520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DAWN KERNS

Provider Business Mailing Address
First Line	:	140 E TOWN ST STE 1450
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-6601
Country	:	US
Telephone Number	:	614-334-6903
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 S CABLE RD
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-3468
Country	:	US
Telephone Number	:	567-387-0130
Fax Number	:

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

Provider Enumeration Date	:	06/16/2023
Last Update Date	:	02/04/2025

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