Justin Nicole Kernodle, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1941 Issued in SC

Practice address

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733

Phone

(843) 402-1037

Fax

(843) 402-1295

NPI assigned

Jul 19, 2013

Last updated

Apr 16, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Miss Justin Nicole Kernodle Professional name

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Bon Secours St Francis Xavier Hospital, Inc.

  • Emergency Medicine Physician
  • Charleston, SC
  • NPI 1770867442
  Medicare reassignment NPD
• Roper Hospital Inc

  dba Roper Hospital ER Berkeley

  • Emergency Medicine Physician
  • Moncks Corner, SC
  • NPI 1104983055
  Medicare reassignment NPD
• Broad River Physicians Group, LLC

  • Emergency Medicine Physician
  • Summerville, SC
  • NPI 1295443000
  Medicare reassignment
• Roper St. Francis Mount Pleasant Hospital

  dba Mt. Pleasant EKG

  • Cardiovascular Disease Physician
  • Mount Pleasant, SC
  • NPI 1629499298
  Medicare reassignment
• Bon Secours St. Francis Xavier Hospital, Inc.

  dba Roper St. Francis Healthcare Pediatrics

  • Pediatrics Physician
  • Charleston, SC
  • NPI 1982583068
  NPD
• Roper Hospital Inc.

  dba Vascular Medicine and Wound Management Clinic

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • N Charleston, SC
  • NPI 1104563758
  NPD
• Roper St. Francis Mount Pleasant Hospital

  dba Roper St. Francis Intensivist Services

  • Critical Care Medicine (Internal Medicine) Physician
  • Mount Pleasant, SC
  • NPI 1578362232
  NPD
• Roper St. Francis Mount Pleasant Hospital

  dba Mount Pleasant Hospital ER

  • Emergency Medicine Physician
  • Mount Pleasant, SC
  • NPI 1649587270
  NPD

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

{
    "created_epoch": "1374192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1477995470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602645",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602645",
            "telephone_number": "843-789-1620",
            "fax_number": "843-724-2454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 HENRY TECKLENBURG DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145733",
            "telephone_number": "843-402-1037",
            "fax_number": "843-402-1295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERNODLE",
        "first_name": "JUSTIN",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-19",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "TL1941",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "1941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2123PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUSTIN",
            "last_name": "KERNODLE",
            "middle_name": "NICOLE",
            "prefix": "MISS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Julia Ann Kepley, MD
• David Eric Keppler, PT
• Kathryn Elizabeth Kerley-Heneidi, FNP
• Andrew Harrison Kern, MD
• Megan Elizabeth Kern, MD
• Patricia Kerns, COTA/L
• Suzanne Elizabeth Kerns, MD
• Ariel Hanoch Kerpel, MD
• Kerr Drug Inc a Delaware Company (Kerr Drug 601)
• Kerr Drug Inc a Delaware Company (Kerr Drug 612)

• Medical Physician Assistant in Charleston, SC
• Providers in Charleston, SC by specialty
• Medical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.