Healthcare Provider Details

I. General information

NPI: 1609228071
Provider Name (Legal Business Name): BROOKE FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S MAIN ST
HOPE AR
71801-6525
US

IV. Provider business mailing address

900 S MAIN ST
HOPE AR
71801-6525
US

V. Phone/Fax

Practice location:
  • Phone: 870-722-6567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberA004800
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: