Healthcare Provider Details

I. General information

NPI: 1710797360
Provider Name (Legal Business Name): SARA LOUISE BERRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 2ND ST W
KALISPELL MT
59901-4414
US

IV. Provider business mailing address

PO BOX 471
KALISPELL MT
59903-0471
US

V. Phone/Fax

Practice location:
  • Phone: 406-909-0895
  • Fax:
Mailing address:
  • Phone: 406-909-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-291441
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: