Provider Demographics
NPI:1023074671
Name:GRASS-FERGUSON, NANCY CAROL (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:CAROL
Last Name:GRASS-FERGUSON
Suffix:
Gender:F
Credentials:NP
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 12248
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2248
Mailing Address - Country:US
Mailing Address - Phone:318-880-8828
Mailing Address - Fax:318-484-4800
Practice Address - Street 1:44 VERSAILLES BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3960
Practice Address - Country:US
Practice Address - Phone:318-201-5307
Practice Address - Fax:318-484-4800
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN042281 AP01440363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1673528Medicaid
LA5T830C923Medicare ID - Type Unspecified
LA1673528Medicaid