Provider Demographics
NPI:1972517977
Name:BERGMAN, MICHAEL SCOTT (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:SCOTT
Other - Last Name:BERGMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:929 FALLEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3540
Mailing Address - Country:US
Mailing Address - Phone:901-853-2336
Mailing Address - Fax:
Practice Address - Street 1:7601 SOUTHCREST PKWY
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4739
Practice Address - Country:US
Practice Address - Phone:662-349-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810193367500000X
UT273250-3120367500000X
OR200860036367500000X
IDRNA-899367500000X
IAD161234367500000X
KS43557575072367500000X
MTAPRN130636367500000X
NVCRNA000533367500000X
WY1322367500000X
NM58180367500000X
WAAP60225469367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered