Healthcare Provider Details

I. General information

NPI: 1992167977
Provider Name (Legal Business Name): TARA ANN BERRY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 NORDIC WAY
FERNDALE WA
98248-5104
US

IV. Provider business mailing address

3610 MERIDIAN ST
BELLINGHAM WA
98225-1732
US

V. Phone/Fax

Practice location:
  • Phone: 360-384-1511
  • Fax: 360-384-5758
Mailing address:
  • Phone: 360-318-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60958683
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: