Provider Demographics
NPI:1104623164
Name:BERRY, KIEBPOLI VICTORIA
Entity type:Individual
Prefix:MS
First Name:KIEBPOLI
Middle Name:VICTORIA
Last Name:BERRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 KOUFAX CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-8213
Mailing Address - Country:US
Mailing Address - Phone:804-475-3263
Mailing Address - Fax:804-825-3031
Practice Address - Street 1:7001 KOUFAX CT
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-8213
Practice Address - Country:US
Practice Address - Phone:804-475-3263
Practice Address - Fax:804-825-3031
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1105186376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator