Healthcare Provider Details

I. General information

NPI: 1790606796
Provider Name (Legal Business Name): HERACHIO WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 51
KENNEDY AL
35574-0051
US

IV. Provider business mailing address

PO BOX 51
KENNEDY AL
35574-0051
US

V. Phone/Fax

Practice location:
  • Phone: 205-482-7172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-201456
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: