Provider Demographics
NPI:1447950910
Name:BERRIOS, KYRA (FNP-BC)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 MEL LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3047
Mailing Address - Country:US
Mailing Address - Phone:302-544-1378
Mailing Address - Fax:
Practice Address - Street 1:3304 DRUMMOND PLZ BLDG 3
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5710
Practice Address - Country:US
Practice Address - Phone:302-454-7520
Practice Address - Fax:302-565-6049
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELG-0012300Medicaid