Provider Demographics
NPI:1639175573
Name:BERRY, PIERRE KINDALL (DO)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:KINDALL
Last Name:BERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 SHELBYVILLE RD STE 531
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5132
Mailing Address - Country:US
Mailing Address - Phone:502-792-0236
Mailing Address - Fax:
Practice Address - Street 1:3901 CENTRAL PIKE STE 500
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3431
Practice Address - Country:US
Practice Address - Phone:502-792-0236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-10-05
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
TNDO1271207Q00000X
TN1271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4037157OtherBLUE CROSS/BLUE SHIELD
TN4037157Medicaid
TNG76110Medicare UPIN
TN3305483Medicare PIN