Individual provider · NPI-1

Kennedy Bergren, PA-C

Physician Assistant · Coon Rapids, MN

NPI number1063361103
StatusActive
Last updated in NPPESMay 5, 2026

Details

NPI
1063361103
Entity type
Individual (NPI-1)
Name
Kennedy Bergren
Credential
PA-C
Sex
Female
Sole proprietor
No
Enumeration date
Jan 22, 2026
Certification date
May 5, 2026
Last updated
May 5, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician Assistant15701MNYes

Practice location

9055 Springbrook Dr Nw
Coon Rapids, MN 55433-5841

Phone 763-780-9155

Mailing address

9055 Springbrook Dr Nw
Coon Rapids, MN 55433-5841

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