Provider Demographics
NPI:1932108826
Name:HERALD, JEFFERY W (CRNP)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:W
Last Name:HERALD
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:JEFFERY
Other - Middle Name:W
Other - Last Name:HERALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:3680 GRANDVIEW PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3411
Mailing Address - Country:US
Mailing Address - Phone:052-971-7500
Mailing Address - Fax:205-971-7572
Practice Address - Street 1:209 W SPRING ST STE 304
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2976
Practice Address - Country:US
Practice Address - Phone:205-971-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-059276363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051534295Medicaid
AL51592536OtherBLUE CROSS & BLUE SHIELD
AL051534295Medicare UPIN