Provider Demographics
NPI:1750053229
Name:HERRING, KARSHANDA
Entity Type:Individual
Prefix:
First Name:KARSHANDA
Middle Name:
Last Name:HERRING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 ERIE LN NW
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-9067
Mailing Address - Country:US
Mailing Address - Phone:601-320-3005
Mailing Address - Fax:
Practice Address - Street 1:2457 ERIE LN NW
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-9067
Practice Address - Country:US
Practice Address - Phone:601-320-3005
Practice Address - Fax:601-990-2226
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide