Provider Demographics
NPI:1144827262
Name:BERREY, ANGELA LYNN (FNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:BERREY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 S HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65259-2640
Mailing Address - Country:US
Mailing Address - Phone:660-651-0587
Mailing Address - Fax:
Practice Address - Street 1:CORIZON
Practice Address - Street 2:1216 E MORGAN ST
Practice Address - City:BOONVLILLLE
Practice Address - State:MO
Practice Address - Zip Code:65233-6523
Practice Address - Country:US
Practice Address - Phone:660-882-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020026935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily