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NPI Code Detail

MEDICARE: MISTY FERGUSSON

MEDICARE: MISTY FERGUSSON
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
1363LF0000XFamily Nurse Practitioner660899TX

General Provider Information

NPI Number : 1336507169
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY FERGUSSON
Provider Business Mailing Address
First Line : 1325 N DICKINSON DR
Second Line :
City : RUSK
State : TX
Zip : 75785-1051
Country : US
Telephone Number : 903-683-3600
Fax Number :
Provider Business Practice Location Address
First Line : 1325 N DICKINSON DR
Second Line :
City : RUSK
State : TX
Zip : 75785-1051
Country : US
Telephone Number : 903-683-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2016
Last Update Date : 02/08/2016

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