Healthcare Provider Details

I. General information

NPI: 1417876772
Provider Name (Legal Business Name): CAROLINE BERRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 STATLER BLVD
STAUNTON VA
24401-4894
US

IV. Provider business mailing address

802 LAMMERMOOR DR
STAUNTON VA
24401-9142
US

V. Phone/Fax

Practice location:
  • Phone: 540-245-7470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: