Basic Information
| Provider Information | |||||||||
| NPI: | 1083051312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4298 DENA JO | ||||||||
| Address2: | APT 160 | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724047888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705300159 | ||||||||
| FaxNumber: | 5012270744 | ||||||||
| Practice Location | |||||||||
| Address1: | 2024 ARKANSAS VALLEY DR | ||||||||
| Address2: | #202 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722124166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012270700 | ||||||||
| FaxNumber: | 5012270744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2013 | ||||||||
| LastUpdateDate: | 05/28/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R084287 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.