Provider Demographics
NPI:1265739114
Name:FERGUSON, LASHONDIA D (ARNP)
Entity type:Individual
Prefix:
First Name:LASHONDIA
Middle Name:D
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 KY 3442
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7554
Mailing Address - Country:US
Mailing Address - Phone:606-545-7332
Mailing Address - Fax:
Practice Address - Street 1:215 TREUHAFT BLVD
Practice Address - Street 2:STE 2
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7361
Practice Address - Country:US
Practice Address - Phone:606-545-0400
Practice Address - Fax:606-545-0433
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006836363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100164240Medicaid
K017051Medicare PIN