Healthcare Provider Details

I. General information

NPI: 1770400574
Provider Name (Legal Business Name): BRANDY LYNN BERGERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 GERSTNER MEMORIAL DR
LAKE CHARLES LA
70601-8162
US

IV. Provider business mailing address

2640 COUNTRY CLUB RD
LAKE CHARLES LA
70605-6078
US

V. Phone/Fax

Practice location:
  • Phone: 337-485-4185
  • Fax:
Mailing address:
  • Phone: 337-426-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number248113
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: