Provider Demographics
NPI:1033562699
Name:BERNHARDT, CALEB ROBERT (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:ROBERT
Last Name:BERNHARDT
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:ALLOUEZ
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1316
Mailing Address - Country:US
Mailing Address - Phone:920-412-8205
Mailing Address - Fax:
Practice Address - Street 1:5005 N. PIEDRAS ST. ATTN EL PASO, TX, 79920-5001
Practice Address - Street 2:WBAMC
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6672-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health