Provider Demographics
NPI:1447258983
Name:KERN-BUELL, CHERYL L (PA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:KERN-BUELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5901
Mailing Address - Country:US
Mailing Address - Phone:419-228-8950
Mailing Address - Fax:419-224-7904
Practice Address - Street 1:770 W HIGH ST STE 350
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5901
Practice Address - Country:US
Practice Address - Phone:419-228-8950
Practice Address - Fax:419-224-7904
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001752363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068184Medicaid
OH970023520Medicare PIN
OH46881Medicare UPIN
OHH091730Medicare PIN
OH76681Medicare PIN