Individual
JESSICA LARYNN BERGMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6965
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6965
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
B201802040
VA
363A00000X
Physician Assistant
Primary
0110009496
VA
Other
Enumeration date
05/17/2023
Last updated
05/03/2024
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