Individual
KENNETH PAUL BERGERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
539 E PRUDHOMME ST, OPELOUSAS, LA 70570-6499
(337) 943-7128
Mailing address
PO BOX 459, OPELOUSAS, LA 70571-0459
(337) 849-5315
(318) 442-1586
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN083404
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1620513
—
LA
Enumeration date
09/20/2005
Last updated
12/14/2018
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