Provider Demographics
NPI:1467827550
Name:HERNDON, SUMMERE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:SUMMERE
Middle Name:
Last Name:HERNDON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:81 AUTUMN LEAF DRIVE
Mailing Address - City:NEW CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26743-0012
Mailing Address - Country:US
Mailing Address - Phone:304-788-7733
Mailing Address - Fax:
Practice Address - Street 1:81 AUTUMN LEAF DRIVE
Practice Address - Street 2:
Practice Address - City:NEW CREEK
Practice Address - State:WV
Practice Address - Zip Code:26743-0012
Practice Address - Country:US
Practice Address - Phone:304-788-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR189527363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics