Individual
JERRY CLIFFORD BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CIT
Contact information
Practice address
8404 BASELINE RD, LITTLE ROCK, AR 72209-4339
(501) 663-0708
(501) 313-4062
Mailing address
8404 BASELINE RD, LITTLE ROCK, AR 72209-4339
(501) 663-0708
(501) 313-4062
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
100
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100
ASACB
AR
Enumeration date
11/16/2020
Last updated
11/16/2020
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