Provider Demographics
NPI:1568102861
Name:HERRERA, KATHRYN REBECCA (PA- C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:REBECCA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:REBECCA
Other - Last Name:MORTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2015 HAILSTON DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2854
Mailing Address - Country:US
Mailing Address - Phone:678-697-0345
Mailing Address - Fax:
Practice Address - Street 1:2015 HAILSTON DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2854
Practice Address - Country:US
Practice Address - Phone:678-697-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant