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General NPI Number Information
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NPI Number | 1265925382
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Entity Type | Individual
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Provider Name | REBECCA LYNN FERGUSON PA
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Gender | Female
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 2021 N MACARTHUR BOULEVARD SUITE 350
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City | IRVING
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State | TX
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Zip | 75061
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Country | US
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Telephone | 918-579-5749
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Fax | 918-579-5762
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Provider Business Mailing Address
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Address Line | 13419 SPRING GROVE AVENUE
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City | DALLAS
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State | TX
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Zip | 75240
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Country | US
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Telephone | 918-579-5749
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Fax | 918-579-5762
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-08148
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3145
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA12783
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License Number State | TX
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