Provider Demographics
NPI:1306347307
Name:BERRY, KIMBERLY GEORGENA (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GEORGENA
Last Name:BERRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 MANUEL DR
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75087-0250
Mailing Address - Country:US
Mailing Address - Phone:414-628-6587
Mailing Address - Fax:
Practice Address - Street 1:7515 GREENVILLE AVE STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3860
Practice Address - Country:US
Practice Address - Phone:214-750-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-24
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily