MEDICARE: MS. CANDACE FERGUSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN.0000488-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265449714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CANDACE FERGUSON NP

Provider Business Mailing Address
First Line	:	129 KANSAS AVE
Second Line	:
City	:	WALSENBURG
State	:	CO
Zip	:	81089-1818
Country	:	US
Telephone Number	:	719-738-5200
Fax Number	:	719-738-2732

Provider Business Practice Location Address
First Line	:	70 CORAL SEA WAY APT 25
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-2256
Country	:	US
Telephone Number	:	719-680-0094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/11/2023

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