Healthcare Provider Details

I. General information

NPI: 1932261724
Provider Name (Legal Business Name): KERSTIN KOHN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

IV. Provider business mailing address

3069 ALAMO DR # 159
VACAVILLE CA
95687-6344
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-2080
  • Fax: 707-784-2269
Mailing address:
  • Phone: 707-373-6692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN461959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: