Provider Demographics
NPI:1821742941
Name:BERGQUIST, JESSICA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:BERGQUIST
Suffix:
Gender:
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 1:800 E CORNWALL ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NE
Mailing Address - Zip Code:68967-9577
Mailing Address - Country:US
Mailing Address - Phone:308-293-0076
Mailing Address - Fax:
Practice Address - Street 1:1215 TIBBALS ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1255
Practice Address - Country:US
Practice Address - Phone:308-995-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant