Kathy A Herren, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085002634 Issued in IL

Practice address

3412 Office Park Drive
Marion, IL 62959

Phone

(618) 993-0404

Fax

(618) 993-1717

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Kathy A Henry Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11869/brand/1/csg/1/fhir/r4
• Direct secure messaging: kathy.herren.1@11869.direct.athenahealth.com

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.

• Pediatric Group LLC

  • Rural Health Clinic/Center
  • Carbondale, IL
  • NPI 1023582038
  NPD (past)
• Pediatric Group LLC

  • Rural Health Clinic/Center
  • Marion, IL
  • NPI 1114129970
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558569600000",
    "number": "1740337237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3412 OFFICE PARK DRIVE",
            "city": "MARION",
            "state": "IL",
            "postal_code": "62959",
            "telephone_number": "618-993-0404",
            "fax_number": "618-993-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 OFFICE PARK DRIVE",
            "city": "MARION",
            "state": "IL",
            "postal_code": "62959",
            "telephone_number": "618-993-0404",
            "fax_number": "618-993-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERREN",
        "first_name": "KATHY",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2019-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085002634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080129117",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "174143",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "10019630",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "E26544",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143870",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "043448",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHY",
            "last_name": "HENRY",
            "middle_name": "A",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kamian Herbst, AAS
• Jane Herman, OD
• Joseph Dwight Herman, MD
• Jerad Hernandez, MSW, LCSW
• Shyla Hernandez, CRSS, MHP
• Rhonda Leigh Herrmann, R.PH
• Steven Paul Herrmann, RPH
• Leigh Ann Hertter, PTA
• William P. Hess Sr., D.P.M.
• Jody S Hestand, LMT

• Physician Assistant in Marion, IL
• Providers in Marion, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2019; 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.