Provider Demographics
NPI:1972640019
Name:BERRY, CHRISTIAN (APN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIAN
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 VERA LN
Mailing Address - Street 2:
Mailing Address - City:LEOMA
Mailing Address - State:TN
Mailing Address - Zip Code:38468-5085
Mailing Address - Country:US
Mailing Address - Phone:193-185-2244
Mailing Address - Fax:
Practice Address - Street 1:325 GERI ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2392
Practice Address - Country:US
Practice Address - Phone:931-762-9797
Practice Address - Fax:931-762-9798
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN129268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily