Provider Demographics
NPI:1700280534
Name:KEARNS, JEANITA (RN/BSN)
Entity type:Individual
Prefix:
First Name:JEANITA
Middle Name:
Last Name:KEARNS
Suffix:
Gender:F
Credentials:RN/BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SHERWOOD DR N
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1311
Mailing Address - Country:US
Mailing Address - Phone:405-714-0762
Mailing Address - Fax:
Practice Address - Street 1:511 SHERWOOD DR N
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1311
Practice Address - Country:US
Practice Address - Phone:405-714-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY692166-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse