Individual
KCY TAVERNIER SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
377 LACLAIR ST, COOS BAY, OR 97420-4709
(541) 756-2057
Mailing address
1040 BLANCO AVE, COOS BAY, OR 97420-2869
(541) 294-8725
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/17/2021
Last updated
12/17/2021
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