Healthcare Provider Details

I. General information

NPI: 1023104254
Provider Name (Legal Business Name): KRISTINE MARIE HERFKENS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 CROASDAILE DR STE 400
DURHAM NC
27705-6806
US

IV. Provider business mailing address

3310 CROASDAILE DR STE 400
DURHAM NC
27705-6806
US

V. Phone/Fax

Practice location:
  • Phone: 919-384-9682
  • Fax:
Mailing address:
  • Phone: 919-384-9682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2192
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: