| NPI | 1073753638 |
|---|---|
| Former Name | CARLY FERGUSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 4708) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01744) |
| 363A00000X Physician Assistant (Licence: OH 50.004349RX) | |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2025-01-29 |