Provider Demographics
NPI:1942541214
Name:BERKLEY, NATASHA (PA-C)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:BERKLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:CROFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1113 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-2539
Mailing Address - Country:US
Mailing Address - Phone:513-814-5769
Mailing Address - Fax:
Practice Address - Street 1:908 SYMMES RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-1842
Practice Address - Country:US
Practice Address - Phone:513-814-5769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1942541214Medicaid