Healthcare Provider Details

I. General information

NPI: 1972640019
Provider Name (Legal Business Name): CHRISTIAN BERRY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 GERI ST SUITE A
LAWRENCEBURG TN
38464-2392
US

IV. Provider business mailing address

20 VERA LN
LEOMA TN
38468-5085
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-9797
  • Fax: 931-762-9798
Mailing address:
  • Phone: 193-185-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number129268
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: