Healthcare Provider Details

I. General information

NPI: 1174404172
Provider Name (Legal Business Name): MEGAN BERGMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LAUREL ST STE 3300
DES MOINES IA
50314-3027
US

IV. Provider business mailing address

PO BOX 674721
DALLAS TX
75267-4721
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-8735
  • Fax: 515-643-8741
Mailing address:
  • Phone: 515-643-2519
  • Fax: 515-643-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-03163
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number138564
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: