Individual
EMILY MONTANA BERGERON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1417 W 78TH ST APT 1213, TULSA, OK 74132-4633
(918) 955-9302
Mailing address
4337 E 57TH ST, TULSA, OK 74135-4237
(918) 955-9302
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
4722
OK
Other
Enumeration date
10/08/2019
Last updated
01/04/2022
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