Provider Demographics
NPI:1033786892
Name:MOUTSOS, CARA FERGUSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:FERGUSON
Last Name:MOUTSOS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-1147
Mailing Address - Country:US
Mailing Address - Phone:814-616-7730
Mailing Address - Fax:
Practice Address - Street 1:2021 E 20TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-1147
Practice Address - Country:US
Practice Address - Phone:814-616-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily