Provider Demographics
NPI:1437499696
Name:HERRON, OLLIE ALICIA (NP-C)
Entity Type:Individual
Prefix:MS
First Name:OLLIE
Middle Name:ALICIA
Last Name:HERRON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 UNION SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38075-7548
Mailing Address - Country:US
Mailing Address - Phone:731-254-6000
Mailing Address - Fax:
Practice Address - Street 1:2520 UNION SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38075-7548
Practice Address - Country:US
Practice Address - Phone:731-254-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily