Provider Demographics
NPI:1407416548
Name:BERRY, SHEALYN (CNP)
Entity Type:Individual
Prefix:
First Name:SHEALYN
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-2989
Mailing Address - Country:US
Mailing Address - Phone:918-786-9009
Mailing Address - Fax:918-787-3724
Practice Address - Street 1:601 E 13TH ST STE ACGH
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2989
Practice Address - Country:US
Practice Address - Phone:918-786-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily