Healthcare Provider Details

I. General information

NPI: 1114882321
Provider Name (Legal Business Name): KONNER HAROLD KERSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 ARCH ST APT 317
CHILLICOTHEE OH
45601-1554
US

IV. Provider business mailing address

478 ARCH ST APT 317
CHILLICOTHEE OH
45601-1554
US

V. Phone/Fax

Practice location:
  • Phone: 518-955-7296
  • Fax:
Mailing address:
  • Phone: 518-955-7296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: