Provider Demographics
NPI:1568213346
Name:MAYBERRY, KAMARA R (MA)
Entity Type:Individual
Prefix:MS
First Name:KAMARA
Middle Name:R
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 TARA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7445
Mailing Address - Country:US
Mailing Address - Phone:702-972-3758
Mailing Address - Fax:
Practice Address - Street 1:4332 TARA AVE APT A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7445
Practice Address - Country:US
Practice Address - Phone:702-972-3758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372600000XNursing Service Related ProvidersAdult Companion