Healthcare Provider Details

I. General information

NPI: 1891759148
Provider Name (Legal Business Name): VALERIE LYNNE BERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 W 40TH AVE SUITE 312
PINE BLUFF AR
71603-6329
US

IV. Provider business mailing address

1609 W 40TH AVE SUITE 312
PINE BLUFF AR
71603-6329
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-3344
  • Fax: 870-534-3517
Mailing address:
  • Phone: 870-534-3344
  • Fax: 870-534-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE4354
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: