Provider Demographics
NPI:1689410367
Name:BERRY, CLARISSA (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:
Last Name:BERRY
Suffix:
Gender:
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:MARIA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 E MAIN ST STE F
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2289
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 E MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2289
Practice Address - Country:US
Practice Address - Phone:385-335-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10698327-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily