MEDICARE: MR. KAHLI K FERGUSON BCBA

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	103K00000X	Behavior Analyst	1-24-70658	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841872009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KAHLI K FERGUSON BCBA

Provider Business Mailing Address
First Line	:	4620 N STATE ROAD 7 STE 300
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5867
Country	:	US
Telephone Number	:	561-323-6593
Fax Number	:

Provider Business Practice Location Address
First Line	:	12276 SAN JOSE BLVD STE 508
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8618
Country	:	US
Telephone Number	:	904-886-3228
Fax Number	:	904-485-8876

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

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/06/2026

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