=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962289793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISTY DAWN FERBERT FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2023
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 CHIMNEY RD
-----------------------------------------------------
City | RINCON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31326-5541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-295-5560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 157 OLD LAKE RD
-----------------------------------------------------
City | GUYTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31312-5916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-663-5251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | RN300064
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------