Provider Demographics
NPI:1912692039
Name:BERRYMAN, DOMINIQUE JANIELLE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:JANIELLE
Last Name:BERRYMAN
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BUSY BEE ST
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:TX
Mailing Address - Zip Code:75925-6258
Mailing Address - Country:US
Mailing Address - Phone:936-645-8457
Mailing Address - Fax:
Practice Address - Street 1:123 BUSY BEE ST
Practice Address - Street 2:
Practice Address - City:ALTO
Practice Address - State:TX
Practice Address - Zip Code:75925-6258
Practice Address - Country:US
Practice Address - Phone:936-645-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114694363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner