Provider Demographics
NPI:1760474886
Name:BERRY, LINDA (APRN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 N WEBB RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1751
Mailing Address - Country:US
Mailing Address - Phone:308-398-1366
Mailing Address - Fax:308-398-1359
Practice Address - Street 1:2121 N WEBB RD STE 100A
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1751
Practice Address - Country:US
Practice Address - Phone:308-398-1366
Practice Address - Fax:308-398-1359
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110095363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE31594OtherBLUE CROSS BLUE SHIELD NE
NE31594OtherBLUE CROSS BLUE SHIELD NE
NEMB0352207OtherDEA #
NES52061Medicare UPIN