Healthcare Provider Details

I. General information

NPI: 1467598151
Provider Name (Legal Business Name): DEBRA LYN HERNDON MSN, FNP-BC, CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA LYN CASSELL CRNFA

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 ROSALINE AVE
REDDING CA
96001-2509
US

IV. Provider business mailing address

PO BOX 496084
REDDING CA
96049-6084
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-6000
  • Fax:
Mailing address:
  • Phone: 530-241-0473
  • Fax: 530-241-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20376
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number498434
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number095006510RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: