Provider Demographics
NPI:1912599960
Name:BERRY, ERIN CHRISTINA (FNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:CHRISTINA
Last Name:BERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:CHRISTINA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-4103
Mailing Address - Country:US
Mailing Address - Phone:417-845-6984
Mailing Address - Fax:417-845-6976
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-4103
Practice Address - Country:US
Practice Address - Phone:417-845-6984
Practice Address - Fax:417-845-6976
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016459363LF0000X
MO2021022691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP11576FMedicaid