NPI 1295376523 · live from the CMS NPI Registry
Emily Montana Bergeron, Physician Assistant
Physician Assistant in Tulsa, OK. National Provider Identifier 1295376523, active.
NPI record
| NPI | 1295376523 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 1417 W 78th St Apt 1213, Tulsa, OK 74132 |
| Practice phone | 918-955-9302 |
| Mailing address | 4337 E 57th St, Tulsa, OK 74135 |
| Enumerated | October 8, 2019 |
| Last updated | January 4, 2022 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant, Medical | 363AM0700X | 4722 (OK) |
| Physician Assistant primary | 363A00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.