Individual provider Active NPI

Bianca Roberta Herndon, LPN

  • Licensed Practical Nurse
  • Fort Campbell, KY
National Provider Identifier
1003864422
Registry record updated Jan 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
66744 Issued in TN
Practice address
BLDG 5979 Desert Storm Ave
Lapointe Health Clinic
Fort Campbell, KY 42223-5349
Phone
(270) 956-0302
NPI assigned
May 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 66744 TN Primary

Addresses

Primary practice location

BLDG 5979 Desert Storm Ave
Lapointe Health Clinic
Fort Campbell, KY 42223-5349

Mailing address

BLDG 5979 Desert Storm Ave
Lapointe Health Clinic
Fort Campbell, KY 42223-5349
Phone (270) 956-0301

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
66744TNMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231372800000",
    "number": "1003864422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLDG 5979 DESERT STORM AVE",
            "address_2": "LAPOINTE HEALTH CLINIC",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235349",
            "telephone_number": "270-956-0301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 5979 DESERT STORM AVE",
            "address_2": "LAPOINTE HEALTH CLINIC",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235349",
            "telephone_number": "270-956-0302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNDON",
        "first_name": "BIANCA",
        "middle_name": "ROBERTA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2009-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TN",
            "license": "66744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Campbell, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.