Healthcare Provider Details

I. General information

NPI: 1437554102
Provider Name (Legal Business Name): KYLE M FERGUSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 05/12/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 OLD MAIN ST STE 1
MAYSVILLE KY
41056-8956
US

IV. Provider business mailing address

601 PERIMETER DR STE 200
LEXINGTON KY
40517-4121
US

V. Phone/Fax

Practice location:
  • Phone: 606-759-7883
  • Fax: 606-759-0683
Mailing address:
  • Phone: 859-278-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04404
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: