Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 201322 | CO |
Y | 124Q00000X | Dental Hygienist | DH4047 | FL |
NPI | 1023362175 |
---|---|
Provider Name | Kimberly Kernohan |
First Address | Ponte Vedra Beach, FL 32082-2542 |
Second Address | Ponte Vedra Beach, FL 32082-2542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2012 |
Last Update Date | 27/10/2012 |