Healthcare Provider Details

I. General information

NPI: 1679576292
Provider Name (Legal Business Name): KATHERINE STIRK FERGUSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N CHINA LAKE BLVD B
RIDGECREST CA
93555-3168
US

IV. Provider business mailing address

1041 N CHINA LAKE BLVD B
RIDGECREST CA
93555-3168
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-6404
  • Fax: 760-446-6415
Mailing address:
  • Phone: 760-446-6404
  • Fax: 760-446-6415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC425540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: