Provider Demographics
NPI:1215637061
Name:BERRY MORGAN, KHAMYIA YVETTE
Entity type:Individual
Prefix:MRS
First Name:KHAMYIA
Middle Name:YVETTE
Last Name:BERRY MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-4919
Mailing Address - Country:US
Mailing Address - Phone:267-670-9036
Mailing Address - Fax:
Practice Address - Street 1:5429 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4919
Practice Address - Country:US
Practice Address - Phone:267-670-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05F6621D174N00000X
PA1809417374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN