Provider Demographics
NPI:1346732922
Name:JEFFERSON-FERGUSON, DEANN RICHELLE (RN, NC-BC)
Entity Type:Individual
Prefix:MS
First Name:DEANN
Middle Name:RICHELLE
Last Name:JEFFERSON-FERGUSON
Suffix:
Gender:F
Credentials:RN, NC-BC
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, NC-BC
Mailing Address - Street 1:3413 PLAINS ST
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-3593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3413 PLAINS ST
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-3593
Practice Address - Country:US
Practice Address - Phone:571-403-2948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX668693163WC1500X, 163WC1600X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development