Provider Demographics
NPI:1114357563
Name:HERALD, JEANNE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:HERALD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:LARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-9775
Mailing Address - Country:US
Mailing Address - Phone:859-858-2814
Mailing Address - Fax:
Practice Address - Street 1:100 VETERANS DR
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-9775
Practice Address - Country:US
Practice Address - Phone:859-858-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008247363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health