Healthcare Provider Details

I. General information

NPI: 1003733619
Provider Name (Legal Business Name): ADAM RICHARD BERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WESTOVER AVE
RICHMOND KY
40475-1043
US

IV. Provider business mailing address

107 WESTOVER AVE
RICHMOND KY
40475-1043
US

V. Phone/Fax

Practice location:
  • Phone: 859-893-6388
  • Fax:
Mailing address:
  • Phone: 859-893-6388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: