Healthcare Provider Details

I. General information

NPI: 1699149021
Provider Name (Legal Business Name): KARLI BERRY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 09/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 SW SEDGWICK RD SUITE 110
PORT ORCHARD WA
98367-6447
US

IV. Provider business mailing address

451 SW SEDGWICK RD SUITE 110
PORT ORCHARD WA
98367-6447
US

V. Phone/Fax

Practice location:
  • Phone: 360-874-5900
  • Fax: 360-874-5959
Mailing address:
  • Phone: 360-874-5900
  • Fax: 360-874-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60690531
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: