Healthcare Provider Details

I. General information

NPI: 1689482135
Provider Name (Legal Business Name): KADI-ANN FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 75TH ST SW STE 210
EVERETT WA
98203-6293
US

IV. Provider business mailing address

20057 BALLINGER WAY NE APT B611
SHORELINE WA
98155-5578
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-4800
  • Fax:
Mailing address:
  • Phone: 253-393-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number60771179
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: