Provider Demographics
NPI:1336700889
Name:BERRY, LAURA KAY (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:BERRY
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KAY
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 LOVE ST
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1734
Mailing Address - Country:US
Mailing Address - Phone:423-735-4160
Mailing Address - Fax:
Practice Address - Street 1:500 LOVE ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1734
Practice Address - Country:US
Practice Address - Phone:423-735-4160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily