Healthcare Provider Details

I. General information

NPI: 1083558191
Provider Name (Legal Business Name): KERA BISPHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1586 W SHAW AVE
FRESNO CA
93711-3502
US

IV. Provider business mailing address

2666 PAMELA DR
MADERA CA
93637-8673
US

V. Phone/Fax

Practice location:
  • Phone: 559-512-3526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: