Individual
KELLY MARIE BERGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2555 COURT DR, SUITE 300, GASTONIA, NC 28054-2134
(704) 868-3256
(704) 868-5870
Mailing address
2555 COURT DR, SUITE 300, GASTONIA, NC 28054-2134
(704) 868-3256
(704) 868-5870
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
162782
NC
363LG0600X
Gerontology Nurse Practitioner
162782
NC
Other
Enumeration date
09/11/2015
Last updated
09/29/2015
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