MRS. JUSTIN NICOLE KERNODLE PA-C NPI 1477995470

NPI Information

NPI: 1477995470
Provider Name: MRS. JUSTIN NICOLE KERNODLE, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
2095 HENRY TECKLENBURG DR
CHARLESTON, SC
ZIP 29414
Phone: (843) 402-1037
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MRS. Justin Nicole Kernodle, PA-C is a medical physician assistant in Charleston, SC. MRS. Justin Nicole Kernodle, PA-C NPI is 1477995470. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2095 HENRY TECKLENBURG DR
CHARLESTON, SC
ZIP 29414-733
Phone: (843) 402-1037
Fax: (843) 402-1295

The NPI 1477995470 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/19/2013 and was last updated on 4/16/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	TL1941	SOUTH CAROLINA	No
2	363AM0700X	Physician Assistant	Medical	1941	SOUTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2123PA	MEDICAID	SOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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