Provider Demographics
NPI:1982095915
Name:BERRY, KATE M (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:M
Last Name:BERRY
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18TH MEDICAL GROUP
Mailing Address - Street 2:UNIT 5142
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96368-5142
Mailing Address - Country:US
Mailing Address - Phone:315-630-5121
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDICAL GROUP UNIT 5142
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5142
Practice Address - Country:US
Practice Address - Phone:315-630-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171452363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health