Provider Demographics
NPI:1215759279
Name:FERGUSON, KATRINA RENEE
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:RENEE
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 1:960 CATTERTON LN
Mailing Address - Street 2:
Mailing Address - City:YEMASSEE
Mailing Address - State:SC
Mailing Address - Zip Code:29945-4209
Mailing Address - Country:US
Mailing Address - Phone:843-599-5120
Mailing Address - Fax:
Practice Address - Street 1:960 CATTERTON LN
Practice Address - Street 2:
Practice Address - City:YEMASSEE
Practice Address - State:SC
Practice Address - Zip Code:29945-4209
Practice Address - Country:US
Practice Address - Phone:843-599-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QG0250X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics