Basic Information
| Provider Information | |||||||||
| NPI: | 1346720505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 406 | ||||||||
| Address2: | |||||||||
| City: | PRESTONSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416530406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049069161 | ||||||||
| FaxNumber: | 6068861316 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 LEFT PENHOOK RD | ||||||||
| Address2: | |||||||||
| City: | HAROLD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416357064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064788787 | ||||||||
| FaxNumber: | 6064784801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2018 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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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 | 363LF0000X | 3012512 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.