Healthcare Provider Details

I. General information

NPI: 1912151416
Provider Name (Legal Business Name): LUCY L FERGUSON L.M., C.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20790 SIBLEY RD
SULPHUR SPRINGS AR
72768-9001
US

IV. Provider business mailing address

20790 SIBLEY RD
SULPHUR SPRINGS AR
72768-9001
US

V. Phone/Fax

Practice location:
  • Phone: 479-298-3409
  • Fax:
Mailing address:
  • Phone: 479-298-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number012002
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: