NPI 1063906741

McKenzie Nicole Herndon, BSW

Practitioner Contractor Valdosta, GA

Practice location

Address: 4141 Old Ivy Trce, Valdosta, GA 31605-5718
Phone: (229) 561-3920

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X

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Registry record

NPI: 1063906741
Entity type: Individual
Sex (as registered): Female
NPI issued: 18 Jun 2018
Record last updated: 18 Jun 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.