MEDICARE: MRS. KATHLEEN BERNADETTE HERNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	ME83379	FL
2	207ND0101X	MOHS-Micrographic Surgery Physician	ME83379	FL
3	207NS0135X	Procedural Dermatology Physician	ME83379	FL
4	207ND0900X	Dermatopathology Physician	ME83379	FL

General Provider Information

NPI Number	:	1871565648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN BERNADETTE HERNE MD

Provider Business Mailing Address
First Line	:	4800 N FEDERAL HWY STE 100C
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-5177
Country	:	US
Telephone Number	:	561-886-0970
Fax Number	:	561-886-0980

Provider Business Practice Location Address
First Line	:	1840 FOREST HILL BLVD
Second Line	:	SUITE 102
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6063
Country	:	US
Telephone Number	:	561-964-6664
Fax Number	:	561-964-8599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	09/01/2016

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