Provider Demographics
NPI:1134341977
Name:BERRY, AMBER LYNN (APRN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
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 1:4577 MILL CREEK ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8149
Mailing Address - Country:US
Mailing Address - Phone:985-226-1118
Mailing Address - Fax:
Practice Address - Street 1:4577 MILL CREEK ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-8149
Practice Address - Country:US
Practice Address - Phone:985-226-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN135107163W00000X
TN12664363LA2100X
LA05453363LA2100X
LA121668163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse