Provider Demographics
NPI:1104216845
Name:FERGUSON, KATHLEEN J (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:J
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-660-5787
Mailing Address - Fax:251-660-5740
Practice Address - Street 1:75 S UNIVERSITY BLVD
Practice Address - Street 2:UCOM 6000 A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0002
Practice Address - Country:US
Practice Address - Phone:251-660-5787
Practice Address - Fax:251-660-5740
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1119813363LG0600X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health