Provider Demographics
NPI:1497170526
Name:FERGESON, MARK GLENNDON (NP-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GLENNDON
Last Name:FERGESON
Suffix:
Gender:M
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 1:1601 SW 89TH ST STE D100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6378
Mailing Address - Country:US
Mailing Address - Phone:405-546-7888
Mailing Address - Fax:
Practice Address - Street 1:1601 SW 89TH ST STE D100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6378
Practice Address - Country:US
Practice Address - Phone:405-546-7888
Practice Address - Fax:844-518-2784
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily