=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427473164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA MAE FERGUSON FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2014
-----------------------------------------------------
Last Update Date | 04/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 HEALTH CENTER RD.
-----------------------------------------------------
City | KYLE
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-455-2451
-----------------------------------------------------
Fax | 605-455-1529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 540
-----------------------------------------------------
City | KYLE
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57752-0540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-455-2451
-----------------------------------------------------
Fax | 605-455-1529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | CP003158
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | R041929
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------