Provider Demographics
NPI:1306240924
Name:BERRY, MANDY (FNP)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:LORENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2022 NEUMANN DR
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-5063
Mailing Address - Country:US
Mailing Address - Phone:570-620-5224
Mailing Address - Fax:
Practice Address - Street 1:303 FM 517 RD E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8630
Practice Address - Country:US
Practice Address - Phone:281-534-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily