Provider Demographics
NPI:1356689103
Name:FERGUSON, MIKI L (APRN)
Entity Type:Individual
Prefix:
First Name:MIKI
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776347
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6347
Mailing Address - Country:US
Mailing Address - Phone:502-272-5052
Mailing Address - Fax:502-629-6217
Practice Address - Street 1:4950 NORTON HEALTHCARE BOULEVARD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2848
Practice Address - Country:US
Practice Address - Phone:502-394-6350
Practice Address - Fax:502-394-6363
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100234060Medicaid
IN201140060Medicaid
KY144543OtherSIHO - NNIKY
KY000000802747OtherANTHEM - NNIKY
KY50047890OtherPASSPORT - NNI
IN201140060Medicaid