MEDICARE: BRIELLE ELAINE BERGERON 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
1	363A00000X	Physician Assistant	10005230A	IN

General Provider Information

NPI Number	:	1972455897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIELLE ELAINE BERGERON PA-C

Provider Business Mailing Address
First Line	:	8051 S EMERSON AVE STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-8632
Country	:	US
Telephone Number	:	317-865-2955
Fax Number	:

Provider Business Practice Location Address
First Line	:	8051 S EMERSON AVE STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-8632
Country	:	US
Telephone Number	:	317-865-2955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	04/08/2026

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Directions to “ BRIELLE ELAINE BERGERON PA-C” Practice Location

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