# EAST LAKE ACUPUNCTURE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** East Lake Acupuncture & Wellness, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356693709
- **Authorized official:** DR. JEANNETTE R KERNS AP, DOM, L.AC. (PRESIDENT)
- **Authorized official phone:** (407) 738-7412

## Contact information

- **Practice address:** 819 E OAK ST STE B, KISSIMMEE, FL 34744-5842
- **Practice address phone:** (407) 738-7412
- **Practice address fax:** (321) 250-7841
- **Mailing address:** PO BOX 700215, SAINT CLOUD, FL 34770-0215
- **Mailing address phone:** (407) 738-7412
- **Mailing address fax:** (321) 250-7841

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | AP 3178 | FL | Yes |

## Other

- **Enumeration date:** 10/10/2012
- **Last updated:** 08/29/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 102479200 | — | FL |
| 01 | — | 12500125 | CAQH | FL |