Provider Demographics
NPI:1972307700
Name:BERRY, JESSICA PAIGE (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:PAIGE
Last Name:BERRY
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:PAIGE
Other - Last Name:DEPTULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16704 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4929
Mailing Address - Country:US
Mailing Address - Phone:302-258-9216
Mailing Address - Fax:
Practice Address - Street 1:16704 KINGS HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4929
Practice Address - Country:US
Practice Address - Phone:302-645-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0013045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily