Healthcare Provider Details

I. General information

NPI: 1487586905
Provider Name (Legal Business Name): ALICE NICOLE FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N STATE ST STE 101
JACKSON MS
39202-2002
US

IV. Provider business mailing address

406 WOODLAKE CV W
BRANDON MS
39047-6093
US

V. Phone/Fax

Practice location:
  • Phone: 601-355-2485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number912764
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: