Provider Demographics
NPI:1063798445
Name:FERGUSON, KIAMESHIA RENEE (LPN/ NCMA)
Entity type:Individual
Prefix:
First Name:KIAMESHIA
Middle Name:RENEE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPN/ NCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 KITRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6024
Mailing Address - Country:US
Mailing Address - Phone:937-657-1787
Mailing Address - Fax:
Practice Address - Street 1:4415 KITRIDGE RD.
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-6024
Practice Address - Country:US
Practice Address - Phone:937-657-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 3747P1801X, 374U00000X
OH170845164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide