Provider Demographics
NPI:1003417734
Name:BERRY, PATSY KAY
Entity Type:Individual
Prefix:
First Name:PATSY
Middle Name:KAY
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PARRISH LN
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:WV
Mailing Address - Zip Code:25009-9091
Mailing Address - Country:US
Mailing Address - Phone:304-836-5505
Mailing Address - Fax:304-836-5413
Practice Address - Street 1:42 PARRISH LN
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:WV
Practice Address - Zip Code:25009-9091
Practice Address - Country:US
Practice Address - Phone:304-836-5505
Practice Address - Fax:304-836-5413
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide