Provider Demographics
NPI:1982441309
Name:BERRY, KHRYSTAL LYNN (RN)
Entity type:Individual
Prefix:
First Name:KHRYSTAL
Middle Name:LYNN
Last Name:BERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 PROVIDENCE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4975
Mailing Address - Country:US
Mailing Address - Phone:541-968-1331
Mailing Address - Fax:
Practice Address - Street 1:2025 PROVIDENCE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4975
Practice Address - Country:US
Practice Address - Phone:541-968-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099000766RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health