Healthcare Provider Details

I. General information

NPI: 1922032317
Provider Name (Legal Business Name): SARA FERGUSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7607 DIXIE HWY
FLORENCE KY
41042-2644
US

IV. Provider business mailing address

1401 MADISON AVE
COVINGTON KY
41011-3313
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-6100
  • Fax: 859-282-8611
Mailing address:
  • Phone: 859-655-6100
  • Fax: 859-655-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM02965
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1052621
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3002188
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: