MEDICARE: CHRISTIAN RANDOLPH KOERNER CNS-AG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	303322	NC
2	364S00000X	Clinical Nurse Specialist	547	NC

General Provider Information

NPI Number	:	1750938635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN RANDOLPH KOERNER CNS-AG

Provider Business Mailing Address
First Line	:	7940 SUMTER RIDGE LN APT 5110
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-6734
Country	:	US
Telephone Number	:	919-400-5011
Fax Number	:	919-400-5809

Provider Business Practice Location Address
First Line	:	7940 SUMTER RIDGE LN APT 5110
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-6734
Country	:	US
Telephone Number	:	910-805-0306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2019
Last Update Date	:	07/31/2023

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