Provider Demographics
NPI:1932109139
Name:FERGUSON, MARY J (WHCNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:WHCNP
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:WISH TUBAL CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-590-5306
Practice Address - Fax:214-590-2798
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX594565363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144870601Medicaid
TX144870602Medicaid
TX144870607Medicaid
TX144870606Medicaid
TX144870608Medicaid
TX144870610Medicaid
TX144870603Medicaid
TX144870611Medicaid
TX144870612Medicaid
TX8N4871OtherBLUE CROSS BLUE SHIELD
TX144870604Medicaid
TX144870605Medicaid
TX144870609Medicaid