MEDICARE: KIMBERLY FERGUSON

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	104100000X	Social Worker	11034	LA

General Provider Information

NPI Number	:	1467217380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY FERGUSON

Provider Business Mailing Address
First Line	:	9420 LINDALE AVE STE ABCD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-4161
Country	:	US
Telephone Number	:	225-442-3540
Fax Number	:

Provider Business Practice Location Address
First Line	:	9420 LINDALE AVE STE ABCD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-4161
Country	:	US
Telephone Number	:	225-442-3540
Fax Number	:

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

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	04/22/2026

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Directions to “ KIMBERLY FERGUSON ” Practice Location

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