Individual
RY WILLIS BERGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
12300 WASHINGTON HWY, ASHLAND, VA 23005-7646
(804) 365-4200
(804) 365-6639
Mailing address
12300 WASHINGTON HWY, ASHLAND, VA 23005-7646
(804) 365-4200
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024181720
VA
Other
Enumeration date
06/29/2021
Last updated
12/09/2025
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