MEDICARE: ANTONIO BERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1851190409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO BERRY

Provider Business Mailing Address
First Line	:	9744 MOCKINGBIRD DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-2013
Country	:	US
Telephone Number	:	402-800-3787
Fax Number	:

Provider Business Practice Location Address
First Line	:	5417 S 122ND ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-3420
Country	:	US
Telephone Number	:	402-594-8032
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/07/2025

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Directions to “ ANTONIO BERRY ” Practice Location

Language	Start Address	Practice Location

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