Provider Demographics
NPI:1629967013
Name:KERGOSIEN, HEVYN BREANNE
Entity type:Individual
Prefix:
First Name:HEVYN
Middle Name:BREANNE
Last Name:KERGOSIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6077 RED CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-9733
Mailing Address - Country:US
Mailing Address - Phone:228-304-5158
Mailing Address - Fax:
Practice Address - Street 1:6077 RED CREEK RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-9733
Practice Address - Country:US
Practice Address - Phone:228-304-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program