Basic Information
| Provider Information | |||||||||
| NPI: | 1447258983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KERN-BUELL | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 W HIGH ST STE 350 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458015901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192288950 | ||||||||
| FaxNumber: | 4192247904 | ||||||||
| Practice Location | |||||||||
| Address1: | 770 W HIGH ST STE 350 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458015901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192288950 | ||||||||
| FaxNumber: | 4192247904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 06/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 50001752 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 0068184 | 05 | OH | MEDICAID |