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NPI Code Detail

MEDICARE: MRS. TAKEDRIA MINGO-BERRY FNP-BC

MEDICARE: MRS. TAKEDRIA MINGO-BERRY FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner2018035915MO
2363LF0000XFamily Nurse Practitioner53-81402-052KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11255816591OTHERMONPI

General Provider Information

NPI Number : 1255816591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAKEDRIA MINGO-BERRY FNP-BC
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4400 E 39TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64128-2818
Country : US
Telephone Number : 816-791-7177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2018
Last Update Date : 02/17/2026

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Directions to “ MRS. TAKEDRIA MINGO-BERRY FNP-BC” Practice Location

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