Provider Demographics
NPI:1659998458
Name:PALMER FERGUSON, CHELSEA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:PALMER FERGUSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-6110
Mailing Address - Country:US
Mailing Address - Phone:940-322-5477
Mailing Address - Fax:
Practice Address - Street 1:1708 DAYTON AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6110
Practice Address - Country:US
Practice Address - Phone:940-322-5477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760103363LP0808X
TX1010476363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health