Provider Demographics
NPI:1467598151
Name:HERNDON, DEBRA LYN (MSN, FNP-BC, CRNFA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYN
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MSN, FNP-BC, CRNFA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYN
Other - Last Name:CASSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNFA
Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:2175 ROSALINE AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2509
Practice Address - Country:US
Practice Address - Phone:530-225-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498434163WR0006X
CA20376363LF0000X
OR095006510RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant