| NPI | 1710431432 |
|---|---|
| Former Name | JACQUELYNN VICTORIA FERGUSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MO 2020039600) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2024-09-26 |