Healthcare Provider Details

I. General information

NPI: 1144544636
Provider Name (Legal Business Name): JENNIFER L BERRY ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 DANNAHER DR STE 100
POWELL TN
37849-4066
US

IV. Provider business mailing address

900 E HILL AVE STE 230
KNOXVILLE TN
37915-2565
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-9330
  • Fax: 865-544-1861
Mailing address:
  • Phone: 865-862-0998
  • Fax: 865-544-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number158618
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20100001103
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14970
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: