Provider Demographics
NPI:1174979777
Name:HERRON, KOREY ROCHELLE
Entity type:Individual
Prefix:MISS
First Name:KOREY
Middle Name:ROCHELLE
Last Name:HERRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 ALASKA AVE
Mailing Address - Street 2:HOUSE
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-1635
Mailing Address - Country:US
Mailing Address - Phone:314-598-8900
Mailing Address - Fax:314-598-8900
Practice Address - Street 1:5230 ALASKA AVE
Practice Address - Street 2:HOUSE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-1635
Practice Address - Country:US
Practice Address - Phone:314-598-8900
Practice Address - Fax:314-598-8900
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide