Provider Demographics
NPI:1760605596
Name:HERRON, DEBORAH KRISTA
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:KRISTA
Last Name:HERRON
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 1:1273 ROSIER ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4729
Mailing Address - Country:US
Mailing Address - Phone:530-306-6770
Mailing Address - Fax:
Practice Address - Street 1:1273 ROSIER ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4729
Practice Address - Country:US
Practice Address - Phone:530-306-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26160167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician