Kacie Lauren Blackwell Berry, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

10030427 Issued in OR

Practice address

213 E Main St
Rogue River, OR 97537-9100

Phone

(541) 714-5610

Fax

(541) 714-5611

NPI assigned

Dec 9, 2019

Last updated

Jan 17, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC, OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Harborside Psychiatry LLC

  • Psychiatry Physician
  • Rogue River, OR
  • NPI 1881404200
  Medicare reassignment NPD Authorized official
• University Medical Associates of the Medical University of South Carol

  dba MUSC Physicians

  • Multi-Specialty Clinic/Center
  • Charleston, SC
  • NPI 1043241110
  Medicare reassignment NPD
• University Medical Associates of the Medical University of South Carol

  dba MUSC PHysicians

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1982678496
  NPD

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

{
    "created_epoch": "1575849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1225675218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 E MAIN ST",
            "city": "ROGUE RIVER",
            "state": "OR",
            "postal_code": "975379100",
            "telephone_number": "541-714-5610",
            "fax_number": "541-714-5611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 E MAIN ST",
            "city": "ROGUE RIVER",
            "state": "OR",
            "postal_code": "975379100",
            "telephone_number": "541-714-5610",
            "fax_number": "541-714-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "KACIE",
        "middle_name": "LAUREN BLACKWELL",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-09",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "10030427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ahr Rogue River Or Alf TRS Sub LLC (Morrow Heights Assisted Living)
• Jessica L Anders
• Marty Lynn Artoff, LMT
• Sherry Arlene Bowman-Harkness, N.S
• Rachel Suzann Boyle, PA-C
• Catherine Jensens Foster Home (Eddy's Old Fashioned Hamburgers)
• Michelle Louise Clarke
• Terrence L Clement II, DC

• Psychiatric/Mental Health Nurse Practitioner in Rogue River, OR
• Providers in Rogue River, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.