Basic Information
| Provider Information | |||||||||
| NPI: | 1861899841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABREGUNDA | ||||||||
| FirstName: | BERNADETTE | ||||||||
| MiddleName: | PAYUMO | ||||||||
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| Credential: | NP-C, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 720085 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785040085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9569614157 | ||||||||
| FaxNumber: | 9566300472 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 W EXPRESSWAY 83 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785033045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566324000 | ||||||||
| FaxNumber: | 9569614286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2014 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP126948 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LG0600X | AP126948 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LP0808X | AP126948 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | P01666642 | 01 | TX | RR MEDICARE | OTHER | 3462095-05 | 05 | TX | MEDICAID | 412738ZSJC | 01 | TX | MEDICARE | OTHER | 0346209502 | 05 | TX | MEDICAID |