MEDICARE: MARK GLENNDON FERGESON NP-C

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	72566	OK

General Provider Information

NPI Number	:	1497170526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK GLENNDON FERGESON NP-C

Provider Business Mailing Address
First Line	:	1601 SW 89TH ST STE D100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6378
Country	:	US
Telephone Number	:	405-546-7888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 SW 89TH ST STE D100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6378
Country	:	US
Telephone Number	:	405-546-7888
Fax Number	:	844-518-2784

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

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	11/02/2023

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