1033693262 NPI number — KARENA RENEE BERRY REGISTERED NURSE

Table of content: KARENA RENEE BERRY REGISTERED NURSE (NPI 1033693262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033693262 NPI number — KARENA RENEE BERRY REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRY
Provider First Name:
KARENA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARNLEY
Provider Other First Name:
KARENA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033693262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
324 E CHESTNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COWETA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74429-2532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-279-6565
Provider Business Mailing Address Fax Number:
918-279-6551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 E CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COWETA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74429-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-279-6565
Provider Business Practice Location Address Fax Number:
918-279-6551
Provider Enumeration Date:
09/24/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  126798 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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