Dezirae E Berry, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

55464 Issued in ID

Practice address

1119 Highland Ave
Clarkston, WA 99403-2836

Phone

(509) 769-2269

Fax

(509) 769-2270

NPI assigned

Jan 9, 2023

Last updated

Oct 8, 2025By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ID, WA2 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

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.

• Tri-State Memorial Hospital

  • Critical Access Hospital
  • Clarkston, WA
  • NPI 1598814352
  Medicare reassignment NPD
• Vannvei LLC

  • Multi-Specialty Clinic/Center
  • Lewiston, ID
  • NPI 1881200517
  Medicare reassignment NPD
• Tri-State Memorial Hospital

  • Critical Access Hospital
  • Clarkston, WA
  • NPI 1760485221
  Medicare reassignment
• Tri-State Memorial Hospital

  • Community Based Hospice Care Agency
  • Clarkston, WA
  • NPI 1831100254
  NPD
• Tri-State Memorial Hospital

  dba Tri State Medical Clinics

  • Family Medicine Physician
  • Clarkston, WA
  • NPI 1932405693
  NPD
• Vannvei LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Clarkston, WA
  • NPI 1124186804
  NPD
• Tri-State Memorial Hospital

  • Home Health Agency
  • Clarkston, WA
  • NPI 1124135215
  NPD (past)

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

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759881600000",
    "number": "1740994268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 17TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835013652",
            "telephone_number": "208-743-8416",
            "fax_number": "208-743-4642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 HIGHLAND AVE",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032836",
            "telephone_number": "509-769-2269",
            "fax_number": "509-769-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "DEZIRAE",
        "middle_name": "E",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-09",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "55464",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "N361446320",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "55464",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faith Bell
• Sara A Berg, M.D.
• Elizabeth Anne Bergendahl, MHA IP
• Kenneth Alan Berger, MD
• Jonelle Berglund
• Barbara A Bieker, BS SW
• Amelia Bieniek
• Nicole Marie Bishop
• Bonnie R Black, SOCIAL WORKER
• Elizabeth Lefft Black, MD

• Family Nurse Practitioner in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.