Provider Demographics
NPI:1942609334
Name:FERGUSON, KIM (CERT BIRTH DOULA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CERT BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3338
Mailing Address - Country:US
Mailing Address - Phone:269-208-7823
Mailing Address - Fax:
Practice Address - Street 1:2820 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3338
Practice Address - Country:US
Practice Address - Phone:269-208-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00020142374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula