Provider Demographics
NPI:1871565648
Name:HERNE, KATHLEEN BERNADETTE (MD)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:BERNADETTE
Last Name:HERNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N FEDERAL HWY STE 100C
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5177
Mailing Address - Country:US
Mailing Address - Phone:561-886-0970
Mailing Address - Fax:561-886-0980
Practice Address - Street 1:1840 FOREST HILL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6063
Practice Address - Country:US
Practice Address - Phone:561-964-6664
Practice Address - Fax:561-964-8599
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83379207N00000X, 207ND0101X, 207NS0135X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH49803Medicare UPIN
FLAK361Medicare PIN
FLE6379XMedicare PIN