Healthcare Provider Details

I. General information

NPI: 1598267759
Provider Name (Legal Business Name): CANDACE NICOLE FERGUSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

800 ROSE ST
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6047
  • Fax: 859-257-3873
Mailing address:
  • Phone: 859-323-6047
  • Fax: 859-257-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3011040
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011040
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: