Provider Demographics
NPI:1053152058
Name:BERRY, ASHLEY KAE (DPM)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KAE
Last Name:BERRY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:KAE
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 WOODLAND AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3203
Mailing Address - Country:US
Mailing Address - Phone:515-241-8595
Mailing Address - Fax:
Practice Address - Street 1:1415 WOODLAND AVE STE 140
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3203
Practice Address - Country:US
Practice Address - Phone:515-241-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA125536213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist