Provider Demographics
NPI:1134503899
Name:FERGUSON, CASSONDRA L (CFRN)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CFRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-442-3517
Mailing Address - Fax:855-540-4722
Practice Address - Street 1:6400 E BROAD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-779-0381
Practice Address - Fax:614-626-8308
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH334444363LF0000X
OHCOA 17588- NPC363LF0000X, 363LF0000X
OHCOA 17588 NP208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine