Provider Demographics
NPI:1043651540
Name:HERRIN, RACHEL SARA (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:SARA
Last Name:HERRIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:SARA
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:18275 N 59TH AVE STE 144
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1253
Mailing Address - Country:US
Mailing Address - Phone:602-843-2300
Mailing Address - Fax:602-843-2310
Practice Address - Street 1:18275 N 59TH AVE STE 144
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1253
Practice Address - Country:US
Practice Address - Phone:602-843-2300
Practice Address - Fax:602-843-2310
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5399207RR0500X, 363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ840234Medicaid
AZ840234Medicaid