Provider Demographics
NPI:1891763330
Name:HERRINGTON, JOHN LYNWOOD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LYNWOOD
Last Name:HERRINGTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0207
Mailing Address - Country:US
Mailing Address - Phone:813-287-5718
Mailing Address - Fax:
Practice Address - Street 1:1141 W BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2571
Practice Address - Country:US
Practice Address - Phone:615-256-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9239367500000X
TNAPN61163367500000X
KY5959A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
12224782OtherPHCS MULTIPLAN
TN4219800OtherBLUE CROSS/BLUE SHIELD
TNP00744318OtherRAILROAD MEDICARE
000000605613OtherANTHEM
TN1505005Medicaid
TN3606175Medicaid
6111077369-$$$$$$$$$OtherHEALTHNET
TN1505005Medicaid
OH$$$$$$$$$00OtherBUREAU OF WORKERS COMP
TN3606175Medicaid
TN3606171Medicare ID - Type Unspecified
12224782OtherPHCS MULTIPLAN
TN4219800OtherBLUE CROSS/BLUE SHIELD
000000605613OtherANTHEM