Provider Demographics
NPI:1770086324
Name:BERRY, CHRISTOPHER C (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:BERRY
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MONTGOMERY HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1896
Mailing Address - Country:US
Mailing Address - Phone:205-783-5900
Mailing Address - Fax:205-683-2468
Practice Address - Street 1:200 MONTGOMERY HWY STE 200
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1896
Practice Address - Country:US
Practice Address - Phone:205-783-5900
Practice Address - Fax:205-683-2468
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1148542363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-148542OtherALABAMA CRNP LICENSE