Healthcare Provider Details

I. General information

NPI: 1144373697
Provider Name (Legal Business Name): DONNA L HERNDON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST STE 230
ASHLAND KY
41101-2868
US

IV. Provider business mailing address

800 SAINT CHRISTOPHER DR
ASHLAND KY
41101
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-4745
  • Fax:
Mailing address:
  • Phone: 606-836-9613
  • Fax: 606-836-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3547P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: