Provider Demographics
NPI:1932324019
Name:FERGUSON, LESA F (APN)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:F
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S HIGHLAND AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-7790
Mailing Address - Country:US
Mailing Address - Phone:731-423-8600
Mailing Address - Fax:731-423-8636
Practice Address - Street 1:1660 S HIGHLAND AVE
Practice Address - Street 2:SUITE J
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7790
Practice Address - Country:US
Practice Address - Phone:731-423-8600
Practice Address - Fax:731-423-8636
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3642100Medicare ID - Type Unspecified
TNQ59522Medicare UPIN