Provider Demographics
NPI:1265449714
Name:FERGUSON, CANDACE (NP)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089-1818
Mailing Address - Country:US
Mailing Address - Phone:719-738-5200
Mailing Address - Fax:719-738-2732
Practice Address - Street 1:70 CORAL SEA WAY APT 25
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2256
Practice Address - Country:US
Practice Address - Phone:719-680-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0000488-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07602501Medicaid
CO533798Medicare ID - Type Unspecified
CO07602501Medicaid