Individual
DAVID N BERGTHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN-ACNP
Contact information
Practice address
54 HOSPITAL DR, OSAGE BEACH, MO 65065-3050
(573) 302-2287
(573) 302-2241
Mailing address
PO BOX 1500, OSAGE BEACH, MO 65065-1500
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
139652
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336331065
—
MO
01
—
135570015
MEDICARE PTAN
MO
01
—
P00750268
RAIL ROAD MEDICARE
MO
Enumeration date
08/16/2007
Last updated
12/07/2012
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