Provider Demographics
NPI:1932541588
Name:KELLIE BERRY-HERT APRN LLC
Entity Type:Organization
Organization Name:KELLIE BERRY-HERT APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERRY-HERT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-504-3707
Mailing Address - Street 1:2808 S 80TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3253
Mailing Address - Country:US
Mailing Address - Phone:402-504-3707
Mailing Address - Fax:402-504-3714
Practice Address - Street 1:2808 S 80TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3253
Practice Address - Country:US
Practice Address - Phone:402-504-3707
Practice Address - Fax:402-504-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty