Provider Demographics
NPI:1124420716
Name:ELLIS-BERRY, KERRY (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:
Last Name:ELLIS-BERRY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14271 METROPOLIS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912
Mailing Address - Country:US
Mailing Address - Phone:239-939-7777
Mailing Address - Fax:239-936-0036
Practice Address - Street 1:14271 METROPOLIS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-939-7777
Practice Address - Fax:239-936-0036
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2923672363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health