Provider Demographics
NPI:1669922100
Name:FERGUSON, SUSANNA (RN, FNP)
Entity type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:MISS
Other - First Name:SUSANNA
Other - Middle Name:
Other - Last Name:BURNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:802 W LAMPASAS ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4536
Mailing Address - Country:US
Mailing Address - Phone:214-732-6714
Mailing Address - Fax:
Practice Address - Street 1:802 W LAMPASAS ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4536
Practice Address - Country:US
Practice Address - Phone:972-875-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily