Provider Demographics
NPI:1639859705
Name:KERN, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KERN
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 1:10459 MOUNTAIN VIEW AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 RAVENSWOOD RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-4022
Practice Address - Country:US
Practice Address - Phone:910-772-6558
Practice Address - Fax:910-270-2290
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant