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General NPI Number Information
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NPI Number | 1174404172
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Entity Type | Individual
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Provider Name | MEGAN BERGMAN
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Gender | Female
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 8110 E 32ND ST N STE 170
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City | WICHITA
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State | KS
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Zip | 67226-2627
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Country | US
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Telephone | 316-330-9700
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Fax | 316-330-9701
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Provider Business Mailing Address
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Address Line | 10850 COPPER CREEK TRL APT 6205
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City | MAIZE
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State | KS
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Zip | 67101-9337
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Country | US
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Telephone | 435-225-5825
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15-03163
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License Number State | KS
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