Healthcare Provider Details

I. General information

NPI: 1548000763
Provider Name (Legal Business Name): EVELYN BERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2769 CATTLE CREEK RD
BRANCHVILLE SC
29432-5945
US

IV. Provider business mailing address

2769 CATTLE CREEK RD
BRANCHVILLE SC
29432-5945
US

V. Phone/Fax

Practice location:
  • Phone: 803-600-6534
  • Fax:
Mailing address:
  • Phone: 803-600-6534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number99590
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29650
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: