Provider Demographics
NPI:1528054335
Name:BERGERON, BARBARA A (FNP)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:A
Last Name:BERGERON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:BILDERBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP BC
Mailing Address - Street 1:2074 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-3372
Mailing Address - Country:US
Mailing Address - Phone:541-851-8110
Mailing Address - Fax:541-851-8114
Practice Address - Street 1:145 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457-9039
Practice Address - Country:US
Practice Address - Phone:541-863-3146
Practice Address - Fax:541-863-3226
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR79044326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR209569Medicaid
S12474Medicare UPIN
OR209569Medicaid