Provider Demographics
NPI:1568915353
Name:FERGUSON, KRISTY D (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:D
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KRISTY
Other - Middle Name:D
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-4100
Mailing Address - Fax:
Practice Address - Street 1:2840 E SKYLINE DR STE 230
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-8005
Practice Address - Country:US
Practice Address - Phone:520-324-1214
Practice Address - Fax:520-324-1281
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ004612Medicaid