Provider Demographics
NPI:1144584293
Name:FERGUSON, STEPHANIE A (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6626
Mailing Address - Country:US
Mailing Address - Phone:540-785-2100
Mailing Address - Fax:540-786-0677
Practice Address - Street 1:4701 SPOTSYLVANIA PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9435
Practice Address - Country:US
Practice Address - Phone:540-785-7810
Practice Address - Fax:540-834-5411
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1144584293Medicaid