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 965
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-0965
Mailing Address - Country:US
Mailing Address - Phone:828-396-3168
Mailing Address - Fax:828-396-8783
Practice Address - Street 1:4132 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-8371
Practice Address - Country:US
Practice Address - Phone:828-396-3168
Practice Address - Fax:828-396-8783
Is Sole Proprietor?:No
Enumeration Date:2012-02-05
Last Update Date:2013-09-10
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
NC176P7OtherBCBS
NC7006068Medicaid
NC8919642Medicaid
NCP01157969OtherRAILROAD MEDICARE
022NUOtherBCBSNC
NCNC5006AMedicare PIN
NCP01157969OtherRAILROAD MEDICARE