Provider Demographics
NPI:1225529563
Name:MAYBERRY, TAMI JO (ARNP)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:JO
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68349-2269
Mailing Address - Country:US
Mailing Address - Phone:402-659-9084
Mailing Address - Fax:402-994-4099
Practice Address - Street 1:140 N 4TH ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:NE
Practice Address - Zip Code:68349-2269
Practice Address - Country:US
Practice Address - Phone:402-659-9084
Practice Address - Fax:402-994-4099
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily