KERA BERGERON (NPI# 1629322607) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1629322607 |
Entity Type | Individual |
Full Name | KERA BERGERON |
Credential | PA-C |
Practice Address |
6025 Walnut Grove Rd Ste 207 Memphis TN 38120-2122 |
Mailing Address |
6077 Primacy Pkwy Ste 140 Memphis TN 38119-5742 |
Practice Telephone | 9012260200 |
Practice Fax Number | 9012260215 |
Mailing Telephone | 9017258347 |
Mailing Fax Number | 9012597637 |
Enumeration Date | 2012-10-30 |
Last Update Date | 2019-08-27 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363AM0700X |
Physician Assistant Specialization: Medical |
2248 | TN | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
2248 | TN | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TN | BCBS | 6186490 | 01 |
TN | Q000115 | 05 | |
TN | MEDICARE | T08648A | 01 |
Street Address |
6025 WALNUT GROVE RD STE 207 |
City | MEMPHIS |
State | TN |
Zip Code | 38120-2122 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1366485179 | Jon Mark Macnaughton | Orthopaedic Surgery | 6025 Walnut Grove Rd Ste 207, Memphis, TN 38120-2122 | 2006-06-13 |
1528617768 | Msk Group, PC | Orthopaedic Surgery | 6025 Walnut Grove Rd Ste 207, Memphis, TN 38120-2122 | 2019-09-10 |
1497868897 | Laurence Williamson Schwartz | Orthopaedic Surgery | 6025 Walnut Grove Rd Ste 207, Memphis, TN 38120-2122 | 2006-08-17 |
1669490736 | Jim Kyle Hudson IIi | Orthopaedic Surgery | 6025 Walnut Grove Rd Ste 207, Memphis, TN 38120-2122 | 2006-07-17 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1093285637 | Cobblestone Midwifery | Midwife | 5617 Ashley Square South, Memphis, TN 38120 | 2018-11-27 |
1649768870 | River City Neuropsychology, Pllc | Psychologist | 1661 International Dr., Suite 400, Memphis, TN 38120 | 2018-04-24 |
1841676152 | Jody Lavaun Clements | Dentist | 795 Ridge Lake Blvd Ste 101, Memphis, TN 38120 | 2015-08-10 |
1578957122 | Christina Lumpkin | Nurse Practitioner | 6305 Humphreys Blvd Ste 101, Memphis, TN 38120 | 2015-03-21 |
1316352099 | Daniel Poor | Emergency Medicine | Baptist Memorial Hospital Memphis, 124 N. Humphrey's Blvd, Memphis, TN 38120 | 2014-06-21 |
1245643246 | Kysha Saleem | Nurse Practitioner | 6027 Walnut Grove Rd., Suite 312, Memphis, TN 38120 | 2014-06-06 |
1376962613 | John Christopher Swearingen | Dentist | 780 Ridge Lake Blvd Ste 101, Memphis, TN 38120 | 2014-04-15 |
1275884645 | Rebecca Leigh Goedecke | Nurse Practitioner | 6215 Humphreys Blvd Ste 301, Memphis, TN 38120 | 2012-09-26 |
1730475179 | Sarah Elizabeth Hammond | Surgery | Plastic Surgery Group, 80 Humphreys Blvd #100, Memphis, TN 38120 | 2011-06-23 |
1922302785 | Daniel L Hester | Nurse Anesthetist, Certified Registered | 1755 Kirby Parkway Suite 330, Memphis, TN 38120 | 2011-01-07 |
Find all providers in zip 38120 |
Taxonomy Code | 363AS0400X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Surgical Technologist |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568910560 | Erica Troia Comstock | Physician Assistant | 7193 Farnham Rd, Memphis, NY 13112-8764 | 2016-09-19 |
1578895546 | Carl H. Harris | Physician Assistant | 6946 Finch Rd, Memphis, TN 38141-8598 | 2010-02-02 |
1831361948 | F & P Certified Surgical Assistants LLC | Physician Assistant | 4793 Northwood Hills Cv, Memphis, TN 38128-1632 | 2008-03-28 |
1265619118 | Jerry Emerson Shaw | Physician Assistant | 3980 New Covington Pike Ste 200, Memphis, TN 38128-2514 | 2008-01-23 |
1508974700 | Mary E Bruce | Physician Assistant | 890 Madison Ave, Memphis, TN 38103-3409 | 2006-08-28 |
1427683796 | Madison Barry | Physician Assistant | 877 Jefferson Ave, Memphis, TN 38103-2807 | 2020-03-07 |
1891340154 | Lauren Elizabeth Whitley | Physician Assistant | 1325 Eastmoreland Ave Ste 365, Memphis, TN 38104-7542 | 2019-08-05 |
1518519057 | Michael Trevor Houseal | Physician Assistant | 1325 Eastmoreland Ave Ste 365, Memphis, TN 38104-7542 | 2019-07-15 |
1427571850 | Kristen Kaplon | Physician Assistant | 6029 Walnut Grove Rd Ste 401, Memphis, TN 38120-2112 | 2017-07-18 |
1316485667 | Kathryn Lee | Physician Assistant | 6025 Walnut Grove Rd Ste 301, Memphis, TN 38120-2123 | 2017-02-07 |
Find all providers in MEMPHIS |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.