Paul Travis Kern, CDAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP 60041391 Issued in WA

Practice address

305 Pacific Ave S Ste 102
Kelso, WA 98626-1638

Phone

(360) 577-7442

Fax

(360) 577-7904

NPI assigned

Jun 12, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Columbia Wellness

  • Case Management Agency
  • Longview, WA
  • NPI 1487659579
  NPD
• Lifeworks NW

  • Mental Health Counselor
  • Portland, OR
  • NPI 1467408013
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1174972947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1847",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "98632",
            "telephone_number": "380-423-0203",
            "fax_number": "360-577-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 PACIFIC AVE S STE 102",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986261638",
            "telephone_number": "360-577-7442",
            "fax_number": "360-577-7904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27777 Inkster Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Farmington Hills",
            "state": "MI",
            "postal_code": "483345326",
            "country_code": "US",
            "telephone_number": "248-436-4400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14255 SW Brigadoon Ct",
            "address_2": "none",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970053369",
            "country_code": "US",
            "telephone_number": "503-641-1475 x0001",
            "fax_number": "503-641-8548",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "720 14th Ave",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "98632",
            "country_code": "US",
            "telephone_number": "360-423-0203",
            "fax_number": "360-577-0269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KERN",
        "first_name": "PAUL",
        "middle_name": "TRAVIS",
        "name_prefix": "Mr.",
        "credential": "CDAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-12",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP 60041391",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OR",
            "license": "16R21",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie L Keener, RN
• Kelso Al, LLC
• Kelso Drug Co
• Kelso School District
• Colleen M Kennedy
• Elena V Khorosheva-Brown, LPN, GEM-STONE THERA
• Danny Barton Kilgore, LPN
• Brandy Kmetz
• Elena Koleva
• Zachariah Kramer, M.D.

• Addiction (Substance Use Disorder) Counselor in Kelso, WA
• Providers in Kelso, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.