Provider Demographics
NPI:1285758151
Name:BERBERICH, KELLEY (RN FNP-C)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:BERBERICH
Suffix:
Gender:F
Credentials:RN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 SUNCAST LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9668
Mailing Address - Country:US
Mailing Address - Phone:916-933-5028
Mailing Address - Fax:915-933-8747
Practice Address - Street 1:1216 SUNCAST LN
Practice Address - Street 2:SUITE 1
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9668
Practice Address - Country:US
Practice Address - Phone:916-933-5028
Practice Address - Fax:916-933-8747
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily