Provider Demographics
NPI:1558093765
Name:BERRY, JESSICA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:BERRY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:HINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-2626
Mailing Address - Country:US
Mailing Address - Phone:660-543-4770
Mailing Address - Fax:660-543-8222
Practice Address - Street 1:600 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-2626
Practice Address - Country:US
Practice Address - Phone:660-543-4770
Practice Address - Fax:660-543-8222
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022023905363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner