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General NPI Number Information
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NPI Number | 1447302062
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Entity Type | Individual
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Provider Name | KELLY K FERGUSON LMLP
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 212 STATE STREET
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City | FORT SCOTT
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State | KS
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Zip | 66701-2031
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Country | US
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Telephone | 620-223-5030
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Fax | 620-223-1650
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Provider Business Mailing Address
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Address Line | 212 STATE STREET PO BOX 704
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City | FORT SCOTT
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State | KS
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Zip | 66701-2031
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Country | US
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Telephone | 620-223-5030
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Fax | 620-223-1650
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LCP 912
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License Number State | KS
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