Healthcare Provider Details

I. General information

NPI: 1336725910
Provider Name (Legal Business Name): JENNA BERRY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA LEWIS

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NW MYHRE RD
SILVERDALE WA
98383-7662
US

IV. Provider business mailing address

1900 NW MYHRE RD
SILVERDALE WA
98383-7662
US

V. Phone/Fax

Practice location:
  • Phone: 564-240-3100
  • Fax: 564-240-3199
Mailing address:
  • Phone: 564-240-3100
  • Fax: 564-240-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61148183
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: