Doctor Name: | STACEY ELAINE BERRY |
NPI Number: | 1487672796 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | RN134597 |
Business Practice Address: | 1061 Harmon Ave Ste. 1d03 Ft Stewart, GA - 31314 |
Business Phone Number: | 9124356633 |
Business Fax Number: | |
Mailing Address: | 1061 Harmon Ave, Ste. 1d03 FT STEWART |
State: | GA |
Postal Code: | 31314 |
Phone Number: | 9124356633 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 11/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN134597 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |