Provider Demographics
NPI:1215286802
Name:FERGUSON, SIERRA (PA)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 E 29TH ST N STE 206
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2183
Mailing Address - Country:US
Mailing Address - Phone:316-260-6762
Mailing Address - Fax:316-260-6763
Practice Address - Street 1:9300 E 29TH ST N STE 206
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2183
Practice Address - Country:US
Practice Address - Phone:316-260-6762
Practice Address - Fax:316-260-6763
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03430363A00000X
KS15-01554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200966590BMedicaid