Healthcare Provider Details

I. General information

NPI: 1417201179
Provider Name (Legal Business Name): KIMBERLY DAWN FERGUSON DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2183 COUNTY STREET 2760
VERDEN OK
73092
US

IV. Provider business mailing address

1027 FERGUSON RD
CHICKASHA OK
73018-6761
US

V. Phone/Fax

Practice location:
  • Phone: 405-453-7321
  • Fax:
Mailing address:
  • Phone: 405-314-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number4952
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: