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General NPI Number Information
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NPI Number | 1528854445
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CARE CLINIC TD PLLC
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 2002 S VIRGINIA ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-3612
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Country | US
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Telephone | 270-874-2026
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 S VIRGINIA ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-3612
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Country | US
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Telephone | 270-874-2026
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Fax | 463-583-8807
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Authorized Official
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Title or Position | OWNER
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Name | TANYA FERGUSON
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Credential | NP
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Telephone | 902-681-1154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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