Provider Demographics
NPI:1174326243
Name:BERRY, KATELYN C (C-FSD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:C
Last Name:BERRY
Suffix:
Gender:F
Credentials:C-FSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PICKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2049
Mailing Address - Country:US
Mailing Address - Phone:541-514-4758
Mailing Address - Fax:
Practice Address - Street 1:102 PICKFORD AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-2049
Practice Address - Country:US
Practice Address - Phone:541-514-4758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula