MR. JESSE DEWAYNE HERRON


Address: 912 S Wood St # Mc913, Chicago, IL 60612-4300
Phone: 3129962200

MR. JESSE DEWAYNE HERRON (NPI# 1841706371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1841706371
Entity Type Individual
Full Name MR. JESSE DEWAYNE HERRON
Credential APRN, CRNP, PMHNP-BC
Practice Address 912 S Wood St # Mc913
Chicago
IL 60612-4300
Mailing Address 912 S Wood St
Chicago
IL 60612-4300
Practice Telephone 3129962200
Enumeration Date 2017-12-20
Last Update Date 2018-02-08
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 163WP0807X Registered Nurse
Specialization: Psych/Mental Health, Child & Adolescent
1-144296 AL Nursing Service Providers
N 163WP0808X Registered Nurse
Specialization: Psych/Mental Health
041460500 IL Nursing Service Providers
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
209.017099 IL Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 912 S WOOD ST # MC913
City CHICAGO
State IL
Zip Code 60612-4300

Providers in the same location

NPI Name Taxonomy Address Enumeration
1437578044 Jason Ryan Soble Clinical Neuropsychologist 912 S Wood St # Mc913, Chicago, IL 60612-4300 2014-04-10

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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

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1982168407 Richardson Psychiatric Nurse Practitioner 3660 N Lake Shore Dr Ste 201, Chicago, IL 60613-5302 2019-01-29
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1790115293 Stacey Marie Meyers Nurse Practitioner 6439 N Sheridan Rd Ste 310, Chicago, IL 60626-5364 2013-11-19
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1104058221 Lester Eugene Lamee Jr. Nurse Practitioner 251 E Huron Street, Northwestern Memorial Hospital, Chicago, IL 60611 2009-08-24
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Competitor

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City CHICAGO
Zip Code 60612

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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