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General NPI Number Information
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NPI Number | 1174983878
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Entity Type | Individual
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Provider Name | ANGELA RENEE BERRY ANP
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Gender | Female
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 1735 HECKLE BLVD UNIT M-S130
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City | ROCK HILL
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State | SC
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Zip | 29732-4803
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Country | US
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Telephone | 803-659-3444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 740013
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City | ATLANTA
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State | GA
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Zip | 30374-0013
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Country | US
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Telephone | 312-733-9730
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Fax | 773-866-8014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2015011469
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5015653
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 25474
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License Number State | SC
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