Provider Demographics
NPI:1578125019
Name:BERRY, MARY ANNE (AGNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:BERRY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GATES BANK RD
Mailing Address - Street 2:
Mailing Address - City:GATES
Mailing Address - State:NC
Mailing Address - Zip Code:27937-9734
Mailing Address - Country:US
Mailing Address - Phone:252-357-8272
Mailing Address - Fax:530-237-1565
Practice Address - Street 1:4 GATES BANK RD
Practice Address - Street 2:
Practice Address - City:GATES
Practice Address - State:NC
Practice Address - Zip Code:27937-9734
Practice Address - Country:US
Practice Address - Phone:252-357-8272
Practice Address - Fax:530-237-1565
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178016363LP2300X
NC5012020363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care