Provider Demographics
NPI:1770392383
Name:BERMEA, LEROY JR (FNP-BC)
Entity type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:BERMEA
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 W GOODWIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4500
Mailing Address - Country:US
Mailing Address - Phone:830-268-5040
Mailing Address - Fax:830-507-3764
Practice Address - Street 1:1746 W GOODWIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4500
Practice Address - Country:US
Practice Address - Phone:830-268-5040
Practice Address - Fax:830-507-3764
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1004681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily