Healthcare Provider Details

I. General information

NPI: 1124598842
Provider Name (Legal Business Name): DAPHNE SABRINA BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 AL HIGHWAY 157
CULLMAN AL
35058-0609
US

IV. Provider business mailing address

12119 COMANCHE TRL SE
HUNTSVILLE AL
35803-2215
US

V. Phone/Fax

Practice location:
  • Phone: 256-737-2000
  • Fax:
Mailing address:
  • Phone: 256-694-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-095482
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: