Healthcare Provider Details

I. General information

NPI: 1871833251
Provider Name (Legal Business Name): HERRIN PEDIATRIC CLINIC-PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 RIVER POINTE DR. STE 120
CONROE TX
77304-2943
US

IV. Provider business mailing address

601 RIVER POINTE DR. STE 120
CONROE TX
77304-2943
US

V. Phone/Fax

Practice location:
  • Phone: 936-788-6060
  • Fax: 936-788-6061
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHI HERRIN
Title or Position: MANAGER
Credential:
Phone: 936-788-6060