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General NPI Number Information
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NPI Number | 1669358933
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Entity Type | Individual
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Provider Name | BREANNE BERGEON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 12881 N IH 35
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City | LIVE OAK
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State | TX
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Zip | 78233-2966
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Country | US
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Telephone | 210-742-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 4510 N LOOP 1604 E APT 2501
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City | SAN ANTONIO
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State | TX
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Zip | 78247-2246
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Country | US
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Telephone | 419-351-5223
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1215635
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License Number State | TX
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