Provider Demographics
NPI:1467488122
Name:HERD, JEAN M (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:M
Last Name:HERD
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PRINCE WILLIAM RD STE A
Mailing Address - Street 2:
Mailing Address - City:DELPHI
Mailing Address - State:IN
Mailing Address - Zip Code:46923-1759
Mailing Address - Country:US
Mailing Address - Phone:765-564-3016
Mailing Address - Fax:765-564-2608
Practice Address - Street 1:901 PRINCE WILLIAM RD STE A
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1759
Practice Address - Country:US
Practice Address - Phone:765-564-3016
Practice Address - Fax:765-564-2608
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000682A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300005107Medicaid
IN300005107Medicaid
P12372Medicare UPIN