Provider Demographics
NPI:1467131466
Name:BERG, CASSIDY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:ANN
Last Name:BERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1565
Mailing Address - Country:US
Mailing Address - Phone:541-386-9500
Mailing Address - Fax:
Practice Address - Street 1:1010 10TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1565
Practice Address - Country:US
Practice Address - Phone:541-386-9500
Practice Address - Fax:541-386-9540
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA221307363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical