Provider Demographics
NPI:1407404841
Name:BERRY, BAILEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BAILEE
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 WASHINGTON ST UNIT B338
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2955
Mailing Address - Country:US
Mailing Address - Phone:435-890-0018
Mailing Address - Fax:
Practice Address - Street 1:3611 WASHINGTON ST UNIT B338
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2955
Practice Address - Country:US
Practice Address - Phone:435-890-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant