Healthcare Provider Details

I. General information

NPI: 1316232002
Provider Name (Legal Business Name): PATRICIA A BERG WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HILLCREST MEDICAL BLVD OFFICE BUILDING II, STE 300
WACO TX
76712
US

IV. Provider business mailing address

1600 PROVIDENCE DR
WACO TX
76707-2261
US

V. Phone/Fax

Practice location:
  • Phone: 254-313-6500
  • Fax: 254-313-4531
Mailing address:
  • Phone: 254-313-4200
  • Fax: 254-313-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number500056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: