MEDICARE: JENNIFER LYNN FERGUSON PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP221012	ME

General Provider Information

NPI Number	:	1295487015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN FERGUSON PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 156
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04402-0156
Country	:	US
Telephone Number	:	618-841-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	108A MAIN RD S
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1204
Country	:	US
Telephone Number	:	207-709-0553
Fax Number	:	207-250-2242

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

Provider Enumeration Date	:	01/23/2022
Last Update Date	:	02/25/2026

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