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General NPI Number Information
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NPI Number | 1114490224
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Entity Type | Individual
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Provider Name | KYLE T BERGAN DNP, APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 5875 E RIVERSIDE BLVD
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City | ROCKFORD
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State | IL
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Zip | 61114-4937
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Country | US
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Telephone | 815-398-9491
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Fax | 815-381-7498
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Provider Business Mailing Address
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Address Line | 1700 W SUMMERDALE AVE APT BSMT
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City | CHICAGO
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State | IL
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Zip | 60640-2068
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Country | US
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Telephone | 217-714-4713
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209017205
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209017205
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 28268975A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704285087
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ000891500
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License Number State | NJ
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71011442A
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License Number State | IN
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Taxonomy #7
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR20578200
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License Number State | NJ
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Taxonomy #8
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 041389716
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License Number State | IL
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