Healthcare Provider Details

I. General information

NPI: 1508279381
Provider Name (Legal Business Name): JEREMY BERBEREIA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 STATE HIGHWAY 248 STE 200
BRANSON MO
65616-4186
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-336-4112
  • Fax: 417-335-4684
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2014017612
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: