Doctor Name: | KEIKO S. BERG |
NPI Number: | 1043325558 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN, BC |
License Number: | APN7893 |
Business Practice Address: | 400 Tulip Grove Rd Hermitage, TN - 370761750 |
Business Phone Number: | 6153911680 |
Business Fax Number: | 6153911827 |
Mailing Address: | 400 Tulip Grove Rd, HERMITAGE |
State: | TN |
Postal Code: | 370761750 |
Phone Number: | 6153911680 |
Fax Number: | 6153911827 |
NPI Enumeration Date: | 08/21/2006 |
NPI Last Update Date: | 10/24/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | APN7893 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |