Provider Demographics
NPI:1336855139
Name:HERRON, MAGGIE (CHES)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:DOLOMITE
Mailing Address - State:AL
Mailing Address - Zip Code:35061-1150
Mailing Address - Country:US
Mailing Address - Phone:205-492-6063
Mailing Address - Fax:
Practice Address - Street 1:1626 JAMES ST
Practice Address - Street 2:
Practice Address - City:DOLOMITE
Practice Address - State:AL
Practice Address - Zip Code:35061-1150
Practice Address - Country:US
Practice Address - Phone:205-492-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29672133N00000X, 133NN1002X, 174H00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL29672Medicaid