Provider Demographics
NPI:1205876760
Name:ADAMS-BERRY, KATHY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:LYNN
Last Name:ADAMS-BERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 COYLE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0305
Mailing Address - Country:US
Mailing Address - Phone:916-961-2021
Mailing Address - Fax:916-961-2022
Practice Address - Street 1:6444 COYLE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-961-2021
Practice Address - Fax:916-961-2022
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82301207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G823010Medicaid
F26591Medicare UPIN
00G823010Medicare ID - Type UnspecifiedPROVIDER NUMBER