Active NPI
Diane E Bergeron, NP
- Adult Health Nurse Practitioner
- The Woodlands, TX
National Provider Identifier
1306018148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 626794
- Practice address
- 1111 Medical Plaza Dr
250
The Woodlands, TX 77380-3240 - Phone
- (281) 296-8788
- Fax
- (281) 419-1291
- NPI assigned
- Apr 1, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 626794 | TX | Primary |
Addresses
Primary practice location
1111 Medical Plaza Dr
250
The Woodlands, TX 77380-3240
Mailing address
PO Box 8307
The Woodlands, TX 77387-8307
Phone (281) 296-8788
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 193009102 | Medicaid | TX | |
| 154240902 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278374400000",
"number": "1306018148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8307",
"city": "THE WOODLANDS",
"state": "TX",
"postal_code": "773878307",
"telephone_number": "281-296-8788",
"fax_number": "281-419-1291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 MEDICAL PLAZA DR",
"address_2": "250",
"city": "THE WOODLANDS",
"state": "TX",
"postal_code": "773803240",
"telephone_number": "281-296-8788",
"fax_number": "281-419-1291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGERON",
"first_name": "DIANE",
"middle_name": "E",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-01",
"last_updated": "2010-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "TX",
"license": "626794",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "193009102",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "154240902",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in The Woodlands, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.