Provider Demographics
NPI:1780202564
Name:FERGUSON, JENNIFER MEGAN (DNP, ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MEGAN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 PIPER ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8703
Mailing Address - Country:US
Mailing Address - Phone:509-750-6428
Mailing Address - Fax:
Practice Address - Street 1:30 S LOUISIANA ST STE 205
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-9003
Practice Address - Country:US
Practice Address - Phone:509-231-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202010613NP-PP363LF0000X
WAAP61068452363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily