Provider Demographics
NPI:1770749913
Name:FERGUSON, PEGGY LEE (CRNP)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:LEE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:LEE
Other - Last Name:KNUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 DON KNOTTS BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-6734
Mailing Address - Country:US
Mailing Address - Phone:304-291-3627
Mailing Address - Fax:304-284-8667
Practice Address - Street 1:215 DON KNOTTS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-6734
Practice Address - Country:US
Practice Address - Phone:304-291-3627
Practice Address - Fax:304-284-8667
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily