MEDICARE: CANDACE M KERNELL CFNP

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	163W00000X	Registered Nurse	856514	TX
2	363L00000X	Nurse Practitioner	AP143246	TX
3	363LF0000X	Family Nurse Practitioner	AP143246	TX
4	363L00000X	Nurse Practitioner	59801	NM

General Provider Information

NPI Number	:	1770133746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE M KERNELL CFNP

Provider Business Mailing Address
First Line	:	546 N. 10TH STREET
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119-0349
Country	:	US
Telephone Number	:	575-355-2414
Fax Number	:	575-355-7894

Provider Business Practice Location Address
First Line	:	546 N. 10TH STREET
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119-0349
Country	:	US
Telephone Number	:	575-355-2414
Fax Number	:	575-355-7894

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

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	07/26/2024

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