Provider Demographics
NPI:1831075076
Name:BERRY PEDIATRICS PLLC
Entity type:Organization
Organization Name:BERRY PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PED. NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CPNP
Authorized Official - Phone:406-344-8278
Mailing Address - Street 1:100 1/2 S MERRILL AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-1669
Mailing Address - Country:US
Mailing Address - Phone:406-344-8278
Mailing Address - Fax:
Practice Address - Street 1:100 1/2 S MERRILL AVE STE 9
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1669
Practice Address - Country:US
Practice Address - Phone:406-344-8278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care