Active NPI
Kossi Sevon, PSY.D.
- Clinical Psychologist
- Kernersville, NC
National Provider Identifier
1215301726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5406
- Practice address
- 1695 Kernersville Medical Pkwy RM 1122
Kernersville, NC 27284-7159 - Phone
- (336) 515-5000
- NPI assigned
- Nov 20, 2015
- Last updated
- Jun 21, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 5406 | NC | Primary |
Addresses
Primary practice location
1695 Kernersville Medical Pkwy RM 1122
Kernersville, NC 27284-7159
Mailing address
1695 Kernersville Medical Pkwy RM 1122
Kernersville, NC 27284-7159
Phone (336) 515-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5406 | NC | MD | Gerontology Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592697600000",
"number": "1215301726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1695 KERNERSVILLE MEDICAL PKWY RM 1122",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272847159",
"telephone_number": "336-515-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1695 KERNERSVILLE MEDICAL PKWY RM 1122",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272847159",
"telephone_number": "336-515-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEVON",
"first_name": "KOSSI",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-20",
"last_updated": "2020-06-21",
"certification_date": "2020-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "5406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.