Healthcare Provider Details

I. General information

NPI: 1831075076
Provider Name (Legal Business Name): BERRY PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S KENDRICK AVE
GLENDIVE MT
59330-1627
US

IV. Provider business mailing address

112 S KENDRICK AVE
GLENDIVE MT
59330-1627
US

V. Phone/Fax

Practice location:
  • Phone: 406-344-8278
  • Fax: 406-831-5449
Mailing address:
  • Phone: 406-344-8278
  • Fax: 406-831-5449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ERICCA BERRY
Title or Position: OWNER / PED. NURSE PRACTITIONER
Credential: DNP, CPNP
Phone: 406-344-8278