Healthcare Provider Details

I. General information

NPI: 1558875344
Provider Name (Legal Business Name): ELISSA PAIGE BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16478 S HIGHWAY 71
WINSLOW AR
72959-9500
US

IV. Provider business mailing address

16478 S HIGHWAY 71
WINSLOW AR
72959-9500
US

V. Phone/Fax

Practice location:
  • Phone: 479-900-3085
  • Fax:
Mailing address:
  • Phone: 479-900-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number428
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: