Provider Demographics
NPI:1497445183
Name:KERNER, JORDYN ASHLY
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:ASHLY
Last Name:KERNER
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 1:1908 POINT DE VUE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5594
Mailing Address - Country:US
Mailing Address - Phone:972-974-2628
Mailing Address - Fax:
Practice Address - Street 1:3130 INLAND EMPIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-6570
Practice Address - Country:US
Practice Address - Phone:909-490-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65204363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant