Provider Demographics
NPI:1497964621
Name:HERRON, TERRY RALPH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:RALPH
Last Name:HERRON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WHITE OAK CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-6100
Mailing Address - Country:US
Mailing Address - Phone:830-734-0994
Mailing Address - Fax:
Practice Address - Street 1:907 E. EUREKA ST.
Practice Address - Street 2:SUITE B
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5880
Practice Address - Country:US
Practice Address - Phone:817-599-9339
Practice Address - Fax:817-599-4901
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX455881367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered