Provider Demographics
NPI:1871092817
Name:HERRON, KATINA M (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:M
Last Name:HERRON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 UNION AVENUE EXT STE 150
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4431
Mailing Address - Country:US
Mailing Address - Phone:901-725-0872
Mailing Address - Fax:901-278-6934
Practice Address - Street 1:2714 UNION AVENUE EXT STE 150
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112
Practice Address - Country:US
Practice Address - Phone:901-725-0872
Practice Address - Fax:901-278-6934
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily