Provider Demographics
NPI:1295361368
Name:SAMPLE, BRENDA FERGUSON (NP-C)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:FERGUSON
Last Name:SAMPLE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 KING ARTHUR PL
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-9115
Mailing Address - Country:US
Mailing Address - Phone:334-624-9475
Mailing Address - Fax:
Practice Address - Street 1:273 KING ARTHUR PL
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-9115
Practice Address - Country:US
Practice Address - Phone:334-624-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF02201190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily