Provider Demographics
NPI:1770739153
Name:BERGEY, KRISTEN LYNN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:LYNN
Last Name:BERGEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LYNN
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:267-339-3603
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:999 ROUTE 73 N STE 301&401
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1227
Practice Address - Country:US
Practice Address - Phone:856-821-6360
Practice Address - Fax:856-821-6361
Is Sole Proprietor?:No
Enumeration Date:2008-08-17
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053657363A00000X
NJ25MP00207700363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant