Provider Demographics
NPI:1194550129
Name:HERRON, KALEIGH (NP)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 FRASIER CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2316
Mailing Address - Country:US
Mailing Address - Phone:239-634-7026
Mailing Address - Fax:
Practice Address - Street 1:187 CHASTAIN RD NW STE 250
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3010
Practice Address - Country:US
Practice Address - Phone:770-218-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN333777207RX0202X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology