Provider Demographics
NPI:1760754881
Name:FERGUSON, MANDY MILLER (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:MILLER
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP-C
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 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:704-978-3549
Practice Address - Street 1:393 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-4180
Practice Address - Country:US
Practice Address - Phone:704-871-2163
Practice Address - Fax:980-829-0484
Is Sole Proprietor?:No
Enumeration Date:2012-02-05
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8919642Medicaid
NCP01157969OtherRAILROAD MEDICARE
022NUOtherBCBSNC
NC176P7OtherBCBS
NC7006068Medicaid
NCNC5006AMedicare PIN
NCP01157969OtherRAILROAD MEDICARE