MEDICARE: JENNIFER C HERRELL CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	0892	KY
2	176B00000X	Midwife	3007455	KY
3	367A00000X	Advanced Practice Midwife	0024172894	VA

General Provider Information

NPI Number	:	1417212267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER C HERRELL CNM

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-302-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 15TH ST NW STE 301
Second Line	:
City	:	NORTON
State	:	VA
Zip	:	24273-1627
Country	:	US
Telephone Number	:	276-439-1470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	12/13/2023

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