Healthcare Provider Details

I. General information

NPI: 1245152792
Provider Name (Legal Business Name): JANAISHA BERRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 GRAND AVE
LENA MS
39094-8994
US

IV. Provider business mailing address

207 ZION HILL RD
MENDENHALL MS
39114-5906
US

V. Phone/Fax

Practice location:
  • Phone: 601-382-5724
  • Fax:
Mailing address:
  • Phone: 601-382-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number908630
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: