Provider Demographics
NPI:1255333571
Name:HERRON, KATHY LYNN (CNM)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:HERRON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MARTLING AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3133
Mailing Address - Country:US
Mailing Address - Phone:914-741-2283
Mailing Address - Fax:914-741-6741
Practice Address - Street 1:1241 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5201
Practice Address - Country:US
Practice Address - Phone:914-421-1500
Practice Address - Fax:914-421-1501
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000334367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01418982Medicaid
NY01418982Medicaid
NYMFM361Medicare ID - Type Unspecified