Provider Demographics
NPI:1811630775
Name:HERRON, KOLBY ASHTON (APRN)
Entity Type:Individual
Prefix:
First Name:KOLBY
Middle Name:ASHTON
Last Name:HERRON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 TUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-1631
Mailing Address - Country:US
Mailing Address - Phone:731-635-4741
Mailing Address - Fax:731-635-3466
Practice Address - Street 1:202 TUCKER AVE
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-1631
Practice Address - Country:US
Practice Address - Phone:731-635-4741
Practice Address - Fax:731-635-3466
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily