DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: KENNEDY BERGREN PA-C

MEDICARE: KENNEDY BERGREN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant15701MN

General Provider Information

NPI Number : 1063361103
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNEDY BERGREN PA-C
Provider Business Mailing Address
First Line : 9055 SPRINGBROOK DR NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-5841
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9055 SPRINGBROOK DR NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-5841
Country : US
Telephone Number : 763-780-9155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2026
Last Update Date : 05/05/2026

Similar Medicare Providers

1407851694 — CRYSTAL M DEXTER MD
Practice Location Address:
9055 SPRINGBROOK DR NW
COON RAPIDS, MN
55433-5841
Practice Phone: 763-780-9155
Practice Fax:
1306833454 — MS. JULIE M JONES D.O.
Practice Location Address:
9055 SPRINGBROOK DR NW
COON RAPIDS, MN
55433-5841
Practice Phone: 763-780-9155
Practice Fax:
1407821671 — DR. DAVID F LABADIE MD
Practice Location Address:
9055 SPRINGBROOK DR NW
COON RAPIDS, MN
55433-5841
Practice Phone: 763-780-9155
Practice Fax:
1275509622 — CHANG-JIANG ZHENG MD
Practice Location Address:
9055 SPRINGBROOK DR NW
COON RAPIDS, MN
55433-5841
Practice Phone: 763-780-9155
Practice Fax:
1467429621 — DR. MARI B ITO MD
Practice Location Address:
9055 SPRINGBROOK DR NW , URGENCY CARE
COON RAPIDS, MN
55433-5841
Practice Phone: 763-236-7144
Practice Fax: 763-236-7733
1013986637 — MARK H. BRAKKE MD
Practice Location Address:
9055 SPRINGBROOK DR NW
COON RAPIDS, MN
55433-5841
Practice Phone: 763-780-9155
Practice Fax:

Directions to “ KENNEDY BERGREN PA-C” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.