Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 71011352A | IN |
NPI | 1023681509 |
---|---|
Provider Name | Kayla Fergus |
First Address | Indianapolis, IN 46203-1807 |
Second Address | Delphi, IN 46923-1759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2021 |
Last Update Date | 21/07/2021 |