Brennan Bergeron, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

221848 Issued in LA

Practice address

2829 4TH Ave Ste 150
Lake Charles, LA 70601-7897

Phone

(337) 480-7800

Fax

(337) 474-4552

NPI assigned

Aug 19, 2021

Last updated

Feb 3, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Psychiatric Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Iowa, LA
  • NPI 1992467641
  NPD Authorized official
• Southwest Louisiana Hospital Association Inc

  dba Lake Charles Memorial Hospital

  • Psychiatric Hospital Unit
  • Lake Charles, LA
  • NPI 1679637805
  NPD
• Elite Medical Wellness LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lake Charles, LA
  • NPI 1346644606
  NPD (past)

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1982370045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123977 DEPT 3977",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753120001",
            "telephone_number": "337-494-2772",
            "fax_number": "337-494-2928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 4TH AVE STE 150",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017897",
            "telephone_number": "337-480-7800",
            "fax_number": "337-474-4552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2802 Hodges St",
            "address_purpose": "LOCATION",
            "city": "Lake Charles",
            "state": "LA",
            "postal_code": "706017368",
            "country_code": "US",
            "telephone_number": "337-419-1873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGERON",
        "first_name": "BRENNAN",
        "credential": "APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "LA",
            "license": "221848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2572458",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Bercier, DO
• John Theodore Bercier, DDS
• Megan Bercier, LOTR
• Edward Carl Bergen, D.O.
• Brandy Lynn Bergeron
• Christine Carol Bergeron, APRN,NNP-BC
• Michael A Bergeron, M.D.
• Orlando Berlanga, OTR
• Dillon L Berlin
• Alisha Bernard, ANP-BC

• Psychiatric/Mental Health Nurse Practitioner in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.