Provider Demographics
NPI:1609584309
Name:FERGUSON, KIMBERLY JOY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOY
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 WINDMILL CR
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:NV
Mailing Address - Zip Code:89002
Mailing Address - Country:US
Mailing Address - Phone:702-306-7369
Mailing Address - Fax:
Practice Address - Street 1:2111 WINDMILL CR
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:NV
Practice Address - Zip Code:89002
Practice Address - Country:US
Practice Address - Phone:702-306-7369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician