Individual provider Active NPI

Kiebpoli Victoria Berry

  • Nursing Home Administrator
  • North Chesterfield, VA
National Provider Identifier
1104623164
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Home AdministratorTaxonomy code 376G00000X
License
1105186 Issued in VA
Practice address
7001 Koufax CT
North Chesterfield, VA 23234-8213
Phone
(804) 475-3263
Fax
(804) 825-3031
NPI assigned
Feb 27, 2025
Last updated
Feb 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Home Administrator 376G00000X 1105186 VA Primary

Addresses

Primary practice location

7001 Koufax CT
North Chesterfield, VA 23234-8213

Mailing address

7001 Koufax CT
North Chesterfield, VA 23234-8213
Phone (804) 475-3263

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1105186VAMDNursing Home Administrator

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1104623164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7001 KOUFAX CT",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232348213",
            "telephone_number": "804-475-3263",
            "fax_number": "804-825-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7001 KOUFAX CT",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232348213",
            "telephone_number": "804-475-3263",
            "fax_number": "804-825-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "KIEBPOLI",
        "middle_name": "VICTORIA",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-27",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376G00000X",
            "taxonomy_group": "",
            "desc": "Nursing Home Administrator",
            "state": "VA",
            "license": "1105186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Chesterfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.