Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | 0010-05335 | NC |
NPI | 1417352568 |
---|---|
Provider Name | John William Kershner |
First Address | Charlotte, NC 28260-0447 |
Second Address | Charlotte, NC 28204-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2014 |
Last Update Date | 08/12/2020 |