Healthcare Provider Details

I. General information

NPI: 1851215552
Provider Name (Legal Business Name): KAYLA FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19435 68TH AVE S STE S102
KENT WA
98032-2114
US

IV. Provider business mailing address

19435 68TH AVE S STE S102
KENT WA
98032-2114
US

V. Phone/Fax

Practice location:
  • Phone: 253-414-1983
  • Fax:
Mailing address:
  • Phone: 253-414-1983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70161907-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: