Provider Demographics
NPI:1164783502
Name:BERRY, JOANNA LEE (FNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LEE
Last Name:BERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BRUNSON ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2500
Mailing Address - Country:US
Mailing Address - Phone:334-347-0584
Mailing Address - Fax:
Practice Address - Street 1:101 E BRUNSON ST STE 200
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2500
Practice Address - Country:US
Practice Address - Phone:334-393-3686
Practice Address - Fax:334-347-4096
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-105643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily