| Doctor Name: | KELLEY BERBERICH |
| NPI Number: | 1285758151 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN FNP-C |
| License Number: | 16721 |
| Business Practice Address: | 1216 Suncast Ln Suite 1 El Dorado Hills, CA - 957629668 |
| Business Phone Number: | 9169335028 |
| Business Fax Number: | 9169338747 |
| Mailing Address: | 1216 Suncast Ln, Suite 1 EL DORADO HILLS |
| State: | CA |
| Postal Code: | 957629668 |
| Phone Number: | 9169335028 |
| Fax Number: | 9159338747 |
| NPI Enumeration Date: | 03/18/2007 |
| NPI Last Update Date: | 01/05/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 16721 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |