Healthcare Provider Details

I. General information

NPI: 1144137936
Provider Name (Legal Business Name): KEVIN CHRISTOPHER BERG JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6875 GRINNELL TRL
CONCORD NC
28025-7633
US

IV. Provider business mailing address

6875 GRINNELL TRL
CONCORD NC
28025-7633
US

V. Phone/Fax

Practice location:
  • Phone: 704-796-6810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number322802
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: