Provider Demographics
NPI:1861070229
Name:BERRY, KAITLIN LEIGH
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:LEIGH
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 1:1215 LEE STREET
Mailing Address - Street 2:MAIL STOP 800422
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:434-924-2224
Mailing Address - Fax:434-982-1530
Practice Address - Street 1:1215 LEE STREET
Practice Address - Street 2:MAIL STOP 800422
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0816
Practice Address - Country:US
Practice Address - Phone:434-924-2224
Practice Address - Fax:434-982-1530
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program