MEDICARE: MISTY DAWN FERBERT FNP

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	363L00000X	Nurse Practitioner	RN300064	GA

General Provider Information

NPI Number	:	1962289793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY DAWN FERBERT FNP

Provider Business Mailing Address
First Line	:	157 OLD LAKE RD
Second Line	:
City	:	GUYTON
State	:	GA
Zip	:	31312-5916
Country	:	US
Telephone Number	:	912-663-5251
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 CHIMNEY RD
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-5541
Country	:	US
Telephone Number	:	912-295-5560
Fax Number	:

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

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	10/21/2025

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