Provider Demographics
NPI:1063076024
Name:BERGEAUX, KAYLA (FNP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BERGEAUX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9023 CAMERON STREET
Mailing Address - Street 2:PO BOX
Mailing Address - City:DUSON
Mailing Address - State:LA
Mailing Address - Zip Code:70529-6831
Mailing Address - Country:US
Mailing Address - Phone:337-873-8244
Mailing Address - Fax:337-873-8274
Practice Address - Street 1:110 W FIRST ST
Practice Address - Street 2:SUITE A
Practice Address - City:DUSON
Practice Address - State:LA
Practice Address - Zip Code:70529
Practice Address - Country:US
Practice Address - Phone:337-873-8244
Practice Address - Fax:337-873-8274
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA204719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA204719OtherNP LICENCE NUMBER