Provider Demographics
NPI:1437680196
Name:BERRY, JASON ARTHUR (PMHNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ARTHUR
Last Name:BERRY
Suffix:
Gender:M
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WALTER REED DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1128
Mailing Address - Country:US
Mailing Address - Phone:336-832-9700
Mailing Address - Fax:
Practice Address - Street 1:700 WALTER REED DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1128
Practice Address - Country:US
Practice Address - Phone:336-832-9700
Practice Address - Fax:336-832-9614
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009721363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily