Healthcare Provider Details

I. General information

NPI: 1891377305
Provider Name (Legal Business Name): ANITA BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 TINKER RD
OKLAHOMA CITY OK
73135-5069
US

IV. Provider business mailing address

5105 TINKER RD
OKLAHOMA CITY OK
73135-5069
US

V. Phone/Fax

Practice location:
  • Phone: 405-923-4193
  • Fax:
Mailing address:
  • Phone: 405-923-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: