Provider Demographics
NPI:1235314063
Name:BERGERON, PAMELA L (RNC WHNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:BERGERON
Suffix:
Gender:F
Credentials:RNC WHNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BERGERON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7620 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2154
Mailing Address - Country:US
Mailing Address - Phone:806-359-5468
Mailing Address - Fax:806-359-7201
Practice Address - Street 1:7620 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2154
Practice Address - Country:US
Practice Address - Phone:806-359-5468
Practice Address - Fax:806-359-7201
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX500603363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner