Provider Demographics
NPI:1588752810
Name:BERTSCHLER, ERICA L (NP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:BERTSCHLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 HIGHWAY 18 STE A
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2769
Mailing Address - Country:US
Mailing Address - Phone:769-241-6207
Mailing Address - Fax:769-241-6218
Practice Address - Street 1:2841 HIGHWAY 18 STE A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2769
Practice Address - Country:US
Practice Address - Phone:769-241-6207
Practice Address - Fax:769-241-6218
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858254363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04370211Medicaid