Provider Demographics
NPI:1609686070
Name:KERNS, ANDREA JUSTINE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JUSTINE
Last Name:KERNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19888 TOWNSHIP ROAD 133
Mailing Address - Street 2:
Mailing Address - City:RUSHSYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43347-9606
Mailing Address - Country:US
Mailing Address - Phone:937-210-6989
Mailing Address - Fax:
Practice Address - Street 1:19888 TOWNSHIP ROAD 133
Practice Address - Street 2:
Practice Address - City:RUSHSYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43347-9606
Practice Address - Country:US
Practice Address - Phone:937-210-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant