Provider Demographics
NPI:1821782392
Name:BERRY KINSEY, TIA ROCHELLE (CCMA)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:ROCHELLE
Last Name:BERRY KINSEY
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-0809
Mailing Address - Country:US
Mailing Address - Phone:513-393-5702
Mailing Address - Fax:
Practice Address - Street 1:405 REED RD APT M
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-4558
Practice Address - Country:US
Practice Address - Phone:419-708-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health