Provider Demographics
NPI:1861899841
Name:ABREGUNDA, BERNADETTE PAYUMO (PMHNP)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:PAYUMO
Last Name:ABREGUNDA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:5771 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5626
Practice Address - Country:US
Practice Address - Phone:702-951-3400
Practice Address - Fax:702-951-3403
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126948363L00000X, 363LG0600X, 363LP0808X
NV844939363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1861899841Medicaid
TX412738ZSJCOtherMEDICARE
TX0346209502Medicaid
TX3462095-05Medicaid
NV844939OtherSTATE LICENSE
TXP01666642OtherRR MEDICARE