Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN435904 | CA |
N | 363LC1500X | Nurse Practitioner - Community Health | RN435904 | CA |
N | 363LX0106X | Nurse Practitioner - Occupational Health | RN435904 | CA |
NPI | 1083606438 |
---|---|
Provider Name | Beverly Jeanne Kemmerling |
First Address | Thousand Oaks, CA 91360-2865 |
Second Address | Santa Clarita, CA 91355-1803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 31/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MK1079830 | DEA NUMBER (01) | CA |