Healthcare Provider Details

I. General information

NPI: 1841981586
Provider Name (Legal Business Name): MR. SEVERIN JAMES KOERNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 S CENTRAL ST STE A
VISALIA CA
93277-4528
US

IV. Provider business mailing address

1021 SAN MARINO AVE
CLOVIS CA
93619-7936
US

V. Phone/Fax

Practice location:
  • Phone: 559-635-4252
  • Fax: 559-635-4281
Mailing address:
  • Phone: 559-420-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: