Provider Demographics
NPI:1598409856
Name:HERRING, KELLY SUE (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUE
Last Name:HERRING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:SUE
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1817 OXMOOR RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3505
Mailing Address - Country:US
Mailing Address - Phone:205-870-4030
Mailing Address - Fax:
Practice Address - Street 1:1817 OXMOOR RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-3505
Practice Address - Country:US
Practice Address - Phone:205-870-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily