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General NPI Number Information
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NPI Number | 1255816591
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Entity Type | Individual
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Provider Name | TAKEDRIA MINGO-BERRY FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 02/17/2026
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Provider Practice Location Address
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Address Line | 4400 E 39TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64128-2818
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Country | US
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Telephone | 816-791-7177
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Fax |
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2018035915
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 53-81402-052
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License Number State | KS
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