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General NPI Number Information
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NPI Number | 1922537547
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Entity Type | Individual
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Provider Name | LAKEITHA LANAY BERRY NP
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Gender | Female
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 3030 ROOSEVELT AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78214-2337
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Country | US
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Telephone | 210-924-8151
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Fax |
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Provider Business Mailing Address
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Address Line | 13523 PAXTON BLVD
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City | SAINT HEDWIG
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State | TX
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Zip | 78152-0497
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Country | US
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Telephone | 785-210-5152
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 0024174876
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 1128046
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024174876
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0024174876
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License Number State | VA
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