Provider Demographics
NPI:1366847667
Name:FERGUSON, BRADLEY (HCP)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:HCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WEDDINGTON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3203
Mailing Address - Country:US
Mailing Address - Phone:606-432-8060
Mailing Address - Fax:513-332-9328
Practice Address - Street 1:77 WEDDINGTON BRANCH RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3203
Practice Address - Country:US
Practice Address - Phone:606-432-8060
Practice Address - Fax:513-332-9328
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1046237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist