Provider Demographics
NPI:1396197489
Name:BERGERON, JESSICA J (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:BERGERON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4077 WEST RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1637
Mailing Address - Country:US
Mailing Address - Phone:607-753-9977
Mailing Address - Fax:
Practice Address - Street 1:32 GRAHAM AVE
Practice Address - Street 2:B-26 VAN HOESEN HALL
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1637
Practice Address - Country:US
Practice Address - Phone:607-753-4811
Practice Address - Fax:607-753-2486
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340768-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily