Healthcare Provider Details

I. General information

NPI: 1083051312
Provider Name (Legal Business Name): LAURA ANN FERGUSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 ARKANSAS VALLEY DR #202
LITTLE ROCK AR
72212-4166
US

IV. Provider business mailing address

4298 DENA JO APT 160
JONESBORO AR
72404-7888
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-0700
  • Fax: 501-227-0744
Mailing address:
  • Phone: 870-530-0159
  • Fax: 501-227-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR084287
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: