Provider Demographics
NPI:1891476859
Name:BERGERON, VICTORIA JAIDE (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:JAIDE
Last Name:BERGERON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N HOSPITAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4041
Mailing Address - Country:US
Mailing Address - Phone:337-385-1972
Mailing Address - Fax:
Practice Address - Street 1:119 FUSELIER STREET
Practice Address - Street 2:
Practice Address - City:ARNAUDVILLE
Practice Address - State:LA
Practice Address - Zip Code:70512
Practice Address - Country:US
Practice Address - Phone:337-284-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily