Provider Demographics
NPI:1467906503
Name:HERRERA, MARY KATHLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:MARY KATHLEEN
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 9TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8083
Mailing Address - Country:US
Mailing Address - Phone:409-729-9200
Mailing Address - Fax:
Practice Address - Street 1:8333 9TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8083
Practice Address - Country:US
Practice Address - Phone:409-729-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29194400OtherTX DRIVER'S LICENSE
TX770857OtherRN LICENSE
TXAP132142OtherFNP LICENSE