Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3012512 | KY |
NPI | 1346720505 |
---|---|
Provider Name | Bonnie Marie Ferguson |
First Address | Prestonsburg, KY 41653-0406 |
Second Address | Harold, KY 41635-7064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |