Provider Demographics
NPI:1851068720
Name:FERGUSON, KYLAN LEIGH
Entity Type:Individual
Prefix:MRS
First Name:KYLAN
Middle Name:LEIGH
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 1:18057 FM 832
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:TX
Mailing Address - Zip Code:75831-6208
Mailing Address - Country:US
Mailing Address - Phone:903-388-4349
Mailing Address - Fax:
Practice Address - Street 1:18057 FM 832
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831-6208
Practice Address - Country:US
Practice Address - Phone:903-388-4349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022556163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse