Healthcare Provider Details

I. General information

NPI: 1467692459
Provider Name (Legal Business Name): INDIA JEANEICE BERRYHILL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 MCFARLAND BLVD
NORTHPORT AL
35476-2838
US

IV. Provider business mailing address

PO BOX 708
JASPER AL
35502-0708
US

V. Phone/Fax

Practice location:
  • Phone: 205-333-1993
  • Fax: 205-333-0293
Mailing address:
  • Phone: 205-387-2253
  • Fax: 205-387-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-078439
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-078439
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: