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General NPI Number Information
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NPI Number | 1720759988
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Entity Type | Individual
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Provider Name | STACY KAY BERRY FNP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 956 W ANEMONE TRL
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City | DILLON
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State | CO
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Zip | 80435-6351
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Country | US
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Telephone | 970-485-6846
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Fax | 970-795-8229
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Provider Business Mailing Address
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Address Line | PO BOX 4868
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City | DILLON
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State | CO
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Zip | 80435-4868
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Country | US
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Telephone | 970-485-6826
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Fax | 970-795-8229
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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 | F09211504
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License Number State | CO
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