Provider Demographics
NPI:1972345155
Name:BERRY, TAYLER NICOLE
Entity type:Individual
Prefix:MS
First Name:TAYLER
Middle Name:NICOLE
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4238 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-9614
Mailing Address - Country:US
Mailing Address - Phone:918-825-1930
Mailing Address - Fax:
Practice Address - Street 1:4238 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-9614
Practice Address - Country:US
Practice Address - Phone:918-825-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist