Provider Demographics
NPI:1124233804
Name:BERRY, CARLA J (RN)
Entity type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:J
Last Name:BERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:J
Other - Last Name:BURNFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10262 MYERS RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44427-9726
Mailing Address - Country:US
Mailing Address - Phone:330-704-8513
Mailing Address - Fax:
Practice Address - Street 1:165 E PARK AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2352
Practice Address - Country:US
Practice Address - Phone:330-544-8005
Practice Address - Fax:330-544-9379
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH186871163WP0807X
OHRN.186871163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210038Medicaid