Individual ProviderWakiya BerryNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address9900 Bren Rd E, Minnetonka, MN 55343-9664(980) 925-2463(704) 208-9361PECOS EnrollmentBased on the most recent information from CMS, provider Wakiya Berry is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1639520364Provider TypeIndividualFull NameBerry, WakiyaGenderFemaleSole ProprietorNoEnumeration Date6/23/2016Last Updated6/26/2020Contact InformationPractice LocationPractice Address9900 Bren Rd E, Minnetonka, MN 55343-9664Phone(980) 925-2463FaxUnlisted FaxMailing LocationMailing Address4202 Lynn Ave, Gastonia, NC 28052-4425Phone(704) 208-9361FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense5008660North Carolina