Provider Demographics
NPI:1710042197
Name:BERRY, REGINALD (CRNA)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2602
Mailing Address - Country:US
Mailing Address - Phone:956-546-4835
Mailing Address - Fax:956-504-2401
Practice Address - Street 1:65 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2602
Practice Address - Country:US
Practice Address - Phone:956-546-4835
Practice Address - Fax:956-504-2401
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX448907367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered