Provider Demographics
NPI:1033693262
Name:BERRY, KARENA RENEE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KARENA
Middle Name:RENEE
Last Name:BERRY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:KARENA
Other - Middle Name:
Other - Last Name:CARNLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:324 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-2532
Mailing Address - Country:US
Mailing Address - Phone:918-279-6565
Mailing Address - Fax:918-279-6551
Practice Address - Street 1:324 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-2532
Practice Address - Country:US
Practice Address - Phone:918-279-6565
Practice Address - Fax:918-279-6551
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK126798163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse