Kenneth Herrick, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95008084 Issued in CA

Practice address

17043 Main St
Hesperia, CA 92345-6055

Phone

(760) 241-6666

Fax

(760) 243-2099

NPI assigned

Jan 29, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: kherrick1259498@direct.llu.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of San Bernardino

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Bernardino, CA
  • NPI 1164467023
  Medicare reassignment NPD
• Vituity Healthcare Services PC

  • Family Medicine Physician
  • Colton, CA
  • NPI 1700642758
  Medicare reassignment NPD
• Vituity Physician Services PC

  • Family Medicine Physician
  • Fontana, CA
  • NPI 1124884176
  Medicare reassignment NPD
• County of San Bernardino

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Apple Valley, CA
  • NPI 1346950904
  NPD
• County of San Bernardino

  • Public Health or Welfare Agency
  • Big Bear Lake, CA
  • NPI 1700056967
  NPD

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

{
    "created_epoch": "1517184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1629576244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12550 HESPERIA RD # 101",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955873",
            "telephone_number": "760-381-7703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17043 MAIN ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923456055",
            "telephone_number": "760-241-6666",
            "fax_number": "760-243-2099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12550 Hesperia Rd # 101",
            "address_purpose": "LOCATION",
            "city": "Victorville",
            "state": "CA",
            "postal_code": "923955873",
            "country_code": "US",
            "telephone_number": "760-381-7703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERRICK",
        "first_name": "KENNETH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-29",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95008084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Marie Hernandez
• Maye Hernandez
• Stephanie Hernandez
• Abigail Herrera
• Samantha Herrera
• Hesperia Clinica Medica Familiar a Medical Corporation
• Hesperia Dental Center Inc.
• Hesperia Fire Protection District
• Hesperia la Salle Pharmacy
• Hesperia Physical Therapy Inc.

• Nurse Practitioner in Hesperia, CA
• Providers in Hesperia, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.