Kylanne Berry, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA61012220 Issued in WA

Practice address

4420 76TH St NE
Marysville, WA 98270-3726

Phone

(360) 651-7491

Fax

(360) 651-7481

NPI assigned

Mar 28, 2017

Last updated

Jan 8, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578441600000",
    "number": "1346772563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "360-651-7491",
            "fax_number": "360-651-7481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 76TH ST NE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982703726",
            "telephone_number": "360-651-7491",
            "fax_number": "360-651-7481"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Old Park Lane Rd",
            "address_purpose": "LOCATION",
            "city": "New Milford",
            "state": "CT",
            "postal_code": "067762507",
            "country_code": "US",
            "telephone_number": "860-355-1149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERRY",
        "first_name": "KYLANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-28",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61012220",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "3801",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cierra J Berger, LMP
• Sarah Eva Bergman Lewis, M.D.
• Jack M. Bergstein, M.D.
• Stacy A Berkenpas, BA
• Konstantin Berov
• Tate Besougloff
• Sirisha Bhamidipaty, D.D.S
• Amanda Nichelle Biddle, LMT
• John Michael Bielser, PT
• Elizabeth Bielstein, ARNP

• Physician Assistant in Marysville, WA
• Providers in Marysville, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; 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.