Healthcare Provider Details

I. General information

NPI: 1972439180
Provider Name (Legal Business Name): KEITH BERRY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 DEBARR RD STE C308
ANCHORAGE AK
99508-2972
US

IV. Provider business mailing address

2741 DEBARR RD STE C308
ANCHORAGE AK
99508-2972
US

V. Phone/Fax

Practice location:
  • Phone: 907-331-3640
  • Fax: 907-331-3647
Mailing address:
  • Phone: 907-331-3640
  • Fax: 907-331-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number255113
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: