Kelsie Lee Embrey-Bergstrom

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1911 Williams Dr
Oxnard, CA 93036-2612

Phone

(805) 981-9250

NPI assigned

Mar 12, 2021

Reactivated

Jul 11, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1851976740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 W KELLY RD",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913203818",
            "telephone_number": "805-340-4775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 WILLIAMS DR",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930362612",
            "telephone_number": "805-981-9250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMBREY-BERGSTROM",
        "first_name": "KELSIE",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-12",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "deactivation_date": "2023-06-21",
        "reactivation_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": "RBT-21-155990",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Estefania Elizalde, LCSW
• Christopher Thomas Ellefson, DPT
• Virginia Anne Elliott II, REGISTERED NURSE
• Carly Ann Ellis
• Kareem Mohamed Elnaka, D.D.S
• Melissa Emery
• Ana Anahit Emirzian, DPM
• Kirsa Emmons
• Encephalogic Medical Group, Inc.
• Julia L Endrizzi Vecci, DMD

• Student in an Organized Health Care Education/Training Program in Oxnard, CA
• Providers in Oxnard, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.