MEDICARE: DEBRA KAY FERGUSON RN, MSN, FNPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	601205	TX

General Provider Information

NPI Number	:	1023105079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA KAY FERGUSON RN, MSN, FNPC

Provider Business Mailing Address
First Line	:	103 TIMBERLAND HWY
Second Line	:
City	:	PINELAND
State	:	TX
Zip	:	75968-4012
Country	:	US
Telephone Number	:	409-584-9933
Fax Number	:	409-584-1754

Provider Business Practice Location Address
First Line	:	103 TIMBERLAND HWY
Second Line	:
City	:	PINELAND
State	:	TX
Zip	:	75968-4012
Country	:	US
Telephone Number	:	409-584-9933
Fax Number	:	409-584-1754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	03/17/2011

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