Provider Demographics
NPI:1881798569
Name:HERRON, JENNIFER MICHELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:HERRON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:GOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:333 CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869
Practice Address - Country:US
Practice Address - Phone:423-733-2216
Practice Address - Fax:423-733-2450
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN51708164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse