Healthcare Provider Details

I. General information

NPI: 1558093765
Provider Name (Legal Business Name): JESSICA MARIE BERRY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MARIE HINTON

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S COLLEGE AVE
WARRENSBURG MO
64093-2626
US

IV. Provider business mailing address

600 S COLLEGE AVE
WARRENSBURG MO
64093-2626
US

V. Phone/Fax

Practice location:
  • Phone: 660-543-4770
  • Fax: 660-543-8222
Mailing address:
  • Phone: 660-543-4770
  • Fax: 660-543-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2022023905
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: