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General NPI Number Information
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NPI Number | 1629576244
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Entity Type | Individual
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Provider Name | KENNETH HERRICK NP
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Gender | Male
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 17043 MAIN ST
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City | HESPERIA
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State | CA
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Zip | 92345-6055
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Country | US
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Telephone | 760-241-6666
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Fax | 760-243-2099
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Provider Business Mailing Address
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Address Line | 12550 HESPERIA RD # 101
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City | VICTORVILLE
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State | CA
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Zip | 92395-5873
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Country | US
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Telephone | 760-381-7703
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95008084
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License Number State | CA
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