Provider Demographics
NPI:1528411394
Name:BERRY, DEBRA H (PARAPROFESSIONAL)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:H
Last Name:BERRY
Suffix:
Gender:F
Credentials:PARAPROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GOINGSNAKE ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3133
Mailing Address - Country:US
Mailing Address - Phone:918-458-4110
Mailing Address - Fax:
Practice Address - Street 1:800 GOINGSNAKE ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3133
Practice Address - Country:US
Practice Address - Phone:918-458-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide