Healthcare Provider Details

I. General information

NPI: 1134847304
Provider Name (Legal Business Name): ELIZABETH ANN BERRY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S WOODS MILL RD STE 150
TOWN AND COUNTRY MO
63017-9528
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 314-269-0335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022021461
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: