Healthcare Provider Details

I. General information

NPI: 1124751854
Provider Name (Legal Business Name): KACI RENEE BERGQUIST CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KACI RENEE MENARD

II. Dates (important events)

Enumeration Date: 07/09/2022
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 AMBASSADOR CAFFERY PKWY STE 302
LAFAYETTE LA
70508-6950
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-3887
  • Fax: 337-470-3896
Mailing address:
  • Phone: 337-470-3887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226636
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: