Provider Demographics
NPI:1932784915
Name:BERG, MICAYLA JOY
Entity Type:Individual
Prefix:MRS
First Name:MICAYLA
Middle Name:JOY
Last Name:BERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICAYLA
Other - Middle Name:JOY
Other - Last Name:WESTENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 415 BOX 6661
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114-0067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HQ MEDDACB
Practice Address - Street 2:UNIT 28037 BLD 700
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:314-590-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program