MEDICARE: EMMA KAYE FERGUS APRN

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	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP.0040419	OH

General Provider Information

NPI Number	:	1770456881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA KAYE FERGUS APRN

Provider Business Mailing Address
First Line	:	120 E DAYTON ST
Second Line	:
City	:	WEST ALEXANDRIA
State	:	OH
Zip	:	45381-1210
Country	:	US
Telephone Number	:	937-733-3513
Fax Number	:

Provider Business Practice Location Address
First Line	:	3038 OLIVE RD
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-2640
Country	:	US
Telephone Number	:	937-208-7050
Fax Number	:

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

Provider Enumeration Date	:	09/25/2025
Last Update Date	:	09/25/2025

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