Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicole Bertram, PA

Individual provider Physician Assistant · NPI 1073299236

Nicole Bertram, PA is a Physician Assistant in Jbsa Lackland, Texas. Graduated from San Juan Bautista School of Medicine in 2023, 3 years ago. Practices with M Reza Mizani MD PA, a 29-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
3
Trained at
San Juan Bautista School of Medicine
Licensed in
TX
In the registry since
2023
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1100 Wilford Hall Loop
Jbsa Lackland, TX 78236-5638
Phone: (210) 292-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA17014 (TX)
Medical Physician Assistant Taxonomy 363AM0700X

Record details

NPI number1073299236
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 23, 2023
Last updated in NPPESApril 10, 2026
Certification dateApril 10, 2026
Mailing address1100 Wilford Hall Loop, Jbsa Lackland, TX 78236-5638

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolSAN JUAN BAUTISTA SCHOOL OF MEDICINE
Graduated 2023 (3 years in practice)
Group practice M Reza Mizani Md Pa — 29 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Jbsa Lackland