Provider Demographics
NPI:1851707822
Name:HERB, KATHRYN FOSTER
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:FOSTER
Last Name:HERB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:FOSTER
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 PARK AT NORTH HILLS ST APT 508
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-2638
Mailing Address - Country:US
Mailing Address - Phone:919-452-4313
Mailing Address - Fax:
Practice Address - Street 1:4551 NEW BERN AVE
Practice Address - Street 2:STE 160
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-556-1008
Practice Address - Fax:919-556-6099
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674666163W00000X
NY339328363LF0000X
FLARNP9438326363LF0000X
NC5012897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018415200Medicaid
NY00695941Medicaid
NYG100000410Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY00695941Medicaid
NY331058Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
FL018415200Medicaid
NY331954Medicare Oscar/Certification