Provider Demographics
NPI:1306036314
Name:BERRY, KRISTIN EMILY (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:EMILY
Last Name:BERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:E
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3640 NW SAMARITAN DR
Mailing Address - Street 2:STE 270
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3784
Mailing Address - Country:US
Mailing Address - Phone:541-768-5300
Mailing Address - Fax:541-768-5251
Practice Address - Street 1:340 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1869
Practice Address - Country:US
Practice Address - Phone:541-526-6635
Practice Address - Fax:541-526-6636
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017373207V00000X
MI5315031830207V00000X
ORDO156086207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology