Provider Demographics
NPI:1104344902
Name:HERRING, NICOLE M (ATC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:HERRING
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2694 HARMON QUARTERS RD
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-8259
Mailing Address - Country:US
Mailing Address - Phone:979-627-5191
Mailing Address - Fax:
Practice Address - Street 1:2694 HARMON QUARTERS RD
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-8259
Practice Address - Country:US
Practice Address - Phone:979-627-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program