Healthcare Provider Details

I. General information

NPI: 1902710379
Provider Name (Legal Business Name): NICOLE CLAYTON BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 FOREMAN LN
BELHAVEN NC
27810-9536
US

IV. Provider business mailing address

268 FOREMAN LN
BELHAVEN NC
27810-9536
US

V. Phone/Fax

Practice location:
  • Phone: 252-945-5926
  • Fax:
Mailing address:
  • Phone: 252-945-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: