Provider Demographics
NPI:1023698263
Name:KERNS, MAKENZIE LYNN
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:LYNN
Last Name:KERNS
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 1:7397 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-6178
Mailing Address - Country:US
Mailing Address - Phone:502-968-2233
Mailing Address - Fax:502-968-2283
Practice Address - Street 1:7397 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-6178
Practice Address - Country:US
Practice Address - Phone:502-968-2233
Practice Address - Fax:502-968-2283
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001466A213ES0103X
KY291008213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery