Healthcare Provider Details

I. General information

NPI: 1356294060
Provider Name (Legal Business Name): MS. COURTNEY L HERRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7217 SE 15TH ST
MIDWEST CITY OK
73110-5235
US

IV. Provider business mailing address

3816 SE 45TH ST
OKLAHOMA CITY OK
73135-2020
US

V. Phone/Fax

Practice location:
  • Phone: 405-671-8640
  • Fax: 405-582-7029
Mailing address:
  • Phone: 405-671-8640
  • Fax: 405-582-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL0067672
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: