Provider Demographics
NPI:1912155565
Name:BERRY, HEATHER A
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:A
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8038 HARDEN OAKS
Mailing Address - Street 2:
Mailing Address - City:QUINLAN
Mailing Address - State:TX
Mailing Address - Zip Code:75474-5653
Mailing Address - Country:US
Mailing Address - Phone:903-268-6912
Mailing Address - Fax:
Practice Address - Street 1:8038 HARDEN OAKS
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474-5653
Practice Address - Country:US
Practice Address - Phone:903-268-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other