Provider Demographics
NPI:1124751854
Name:BERGQUIST, KACI RENEE (CNP)
Entity type:Individual
Prefix:MRS
First Name:KACI
Middle Name:RENEE
Last Name:BERGQUIST
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:RENEE
Other - Last Name:MENARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-3887
Mailing Address - Fax:
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY STE 302
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6950
Practice Address - Country:US
Practice Address - Phone:337-470-3887
Practice Address - Fax:337-470-3896
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA226636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily