Provider Demographics
NPI:1699149021
Name:BERRY, KARLI (NP-C)
Entity type:Individual
Prefix:
First Name:KARLI
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 SW SEDGWICK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6447
Mailing Address - Country:US
Mailing Address - Phone:360-874-5900
Mailing Address - Fax:360-874-5959
Practice Address - Street 1:451 SW SEDGWICK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6447
Practice Address - Country:US
Practice Address - Phone:360-874-5900
Practice Address - Fax:360-874-5959
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60690531363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily