Healthcare Provider Details

I. General information

NPI: 1952079709
Provider Name (Legal Business Name): DEBORAH LYNN FERGUSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH FERGUSON

II. Dates (important events)

Enumeration Date: 09/04/2021
Last Update Date: 09/04/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ROCKLEIGH PL
HOUSTON TX
77017-2516
US

IV. Provider business mailing address

1000 OAK RIDGE RD
WILLIS TX
77378-2864
US

V. Phone/Fax

Practice location:
  • Phone: 281-974-1378
  • Fax:
Mailing address:
  • Phone: 812-346-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number1046381
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: