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General NPI Number Information
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NPI Number | 1174397996
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Entity Type | Individual
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Provider Name | LYNETTE HERRERA
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Gender | Female
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 19010 PREIST BLVD
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City | LYTLE
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State | TX
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Zip | 78052-3486
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Country | US
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Telephone | 830-772-9865
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Fax |
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Provider Business Mailing Address
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Address Line | 310 W OAKLAWN RD
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City | PLEASANTON
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State | TX
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Zip | 78064-4033
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Country | US
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Telephone | 830-569-8940
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Fax | 830-224-6905
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1176228
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 707382
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License Number State | TX
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