Individual
KATEY PONDER BERGERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5000 HENNESSY BLVD, BATON ROUGE, LA 70808-4375
(225) 765-8853
(225) 765-1700
Mailing address
5000 HENNESSY BLVD, BATON ROUGE, LA 70808-4375
(225) 765-8853
(225) 765-1700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200119
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04655037
—
MS
05
—
1369497
—
LA
Enumeration date
06/29/2007
Last updated
05/20/2015
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