Provider Demographics
NPI:1356645097
Name:BERRY, LINDA GAIL (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:GAIL
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 1:1124 W RIVERSIDE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1109
Mailing Address - Country:US
Mailing Address - Phone:385-590-0044
Mailing Address - Fax:
Practice Address - Street 1:77 ANTOSKI RD
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:AK
Practice Address - Zip Code:99741
Practice Address - Country:US
Practice Address - Phone:907-656-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1804892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004593200Medicaid