Healthcare Provider Details

I. General information

NPI: 1710026257
Provider Name (Legal Business Name): KELLIE L BERRY-HERT NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CAPITOL AVE STE 1700
LITTLE ROCK AR
72201-3438
US

IV. Provider business mailing address

4201 S 36TH ST
OMAHA NE
68107-1324
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone: 402-917-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberA004240
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: