Active NPI
Latishia Renee-Denise Berry, ANP-BC
- Nurse Practitioner
- Troy, MI
National Provider Identifier
1649614009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704277302
- Practice address
- 880 W Long Lake Rd
Troy, MI 48098-4504 - Phone
- (888) 562-5442
- Fax
- (562) 528-5595
- NPI assigned
- Apr 29, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704277302 | MI | Primary |
Addresses
Primary practice location
880 W Long Lake Rd
Troy, MI 48098-4504
Mailing address
200 Oceangate Ste 100
Long Beach, CA 90802-4317
Phone (562) 499-6191
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704277302 | MI | MD | Nurse Practitioner |
Interoperability endpoints
- ms_lberry51@landmarkhealth-direct.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515628800000",
"number": "1649614009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 OCEANGATE STE 100",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908024317",
"telephone_number": "562-499-6191",
"fax_number": "562-499-6171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "880 W LONG LAKE RD",
"city": "TROY",
"state": "MI",
"postal_code": "480984504",
"telephone_number": "888-562-5442",
"fax_number": "562-528-5595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERRY",
"first_name": "LATISHIA",
"middle_name": "RENEE-DENISE",
"credential": "ANP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-29",
"last_updated": "2018-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704277302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.