Basic Information
| Provider Information | |||||||||
| NPI: | 1417212267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRELL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 W STONE DR STE 6A | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376603256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234087220 | ||||||||
| FaxNumber: | 4234087405 | ||||||||
| Practice Location | |||||||||
| Address1: | 1980 HOLTON AVE E STE 301 | ||||||||
| Address2: | |||||||||
| City: | BIG STONE GAP | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242193367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765230390 | ||||||||
| FaxNumber: | 2765235514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2012 | ||||||||
| LastUpdateDate: | 02/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 0892 | KY | N | Other Service Providers | Midwife | 176B00000X | 3007455 | KY | N | Other Service Providers | Midwife | 176B00000X | 0024172894 | VA | Y | Other Service Providers | Midwife |
No ID Information.