MEDICARE: EAST LAKE ACUPUNCTURE, LLC

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	171100000X	Acupuncturist	AP 3178	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	12500125	OTHER	FL	CAQH

General Provider Information

NPI Number	:	1356693709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST LAKE ACUPUNCTURE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 700215
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34770-0215
Country	:	US
Telephone Number	:	407-738-7412
Fax Number	:	321-250-7841

Provider Business Practice Location Address
First Line	:	819 E OAK ST STE B
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-5842
Country	:	US
Telephone Number	:	407-738-7412
Fax Number	:	321-250-7841

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEANNETTE R KERNS
Credential	:	AP, DOM, L.AC.
Telephone Number	:	407-738-7412

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	08/29/2025

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Directions to “EAST LAKE ACUPUNCTURE, LLC ” Practice Location

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