Healthcare Provider Details

I. General information

NPI: 1134341977
Provider Name (Legal Business Name): AMBER LYNN BERRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4577 MILL CREEK ST
HOUMA LA
70360-8149
US

IV. Provider business mailing address

4577 MILL CREEK ST
HOUMA LA
70360-8149
US

V. Phone/Fax

Practice location:
  • Phone: 985-226-1118
  • Fax:
Mailing address:
  • Phone: 985-226-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number12664
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number05453
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number135107
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number121668
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: