Provider Demographics
NPI:1447935150
Name:HERRON, NATHANIEL BLAINE (RN, BSN)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:BLAINE
Last Name:HERRON
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 STATE HIGHWAY 121 FL 6
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4561
Mailing Address - Country:US
Mailing Address - Phone:469-834-6638
Mailing Address - Fax:
Practice Address - Street 1:4400 STATE HIGHWAY 121 FL 6
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4561
Practice Address - Country:US
Practice Address - Phone:469-834-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX731759163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse