Provider Demographics
NPI:1972121945
Name:BERGH, JOCELYN REBECCA (PA)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:REBECCA
Last Name:BERGH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N NORBECK ST APT 134
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-2859
Mailing Address - Country:US
Mailing Address - Phone:605-200-0721
Mailing Address - Fax:
Practice Address - Street 1:109 PUGH ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:SD
Practice Address - Zip Code:57551-7700
Practice Address - Country:US
Practice Address - Phone:605-685-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant