Provider Demographics
NPI:1558930099
Name:BERRY, MEGAN LEIGH (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LEIGH
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:LEIGH
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:65 ACORN ALY
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-5564
Mailing Address - Country:US
Mailing Address - Phone:850-377-7273
Mailing Address - Fax:
Practice Address - Street 1:65 ACORN ALY
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-5564
Practice Address - Country:US
Practice Address - Phone:850-377-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-20
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL86066889133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered