Provider Demographics
NPI:1235157330
Name:BERRY-TAYLOR, DEBORAH J (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:BERRY-TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SIGMA DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7715
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:899 ISLAND PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492
Practice Address - Country:US
Practice Address - Phone:843-856-6402
Practice Address - Fax:843-216-5068
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1269Medicaid
SCP00846493OtherRR MEDICARE
SCGP1553OtherMEDICAID GROUP #
SCP939648798Medicare PIN
SCGP1553OtherMEDICAID GROUP #
SCNP1269Medicaid
SCP939647126Medicare PIN