MEDICARE: MRS. DESIREE D HERMAN NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	215223	AR

General Provider Information

NPI Number	:	1932591179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DESIREE D HERMAN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	812 N ARKANSAS AVE
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-3867
Country	:	US
Telephone Number	:	479-449-1085
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 N ARKANSAS AVE
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-3867
Country	:	US
Telephone Number	:	479-449-1085
Fax Number	:

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

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	04/16/2026

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