Provider Demographics
NPI:1215497847
Name:FERGUSON, NICOLE ELFORD (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELFORD
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-694-0062
Mailing Address - Fax:865-697-7907
Practice Address - Street 1:6484 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4863
Practice Address - Country:US
Practice Address - Phone:865-633-0235
Practice Address - Fax:865-602-7757
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3811363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ049445Medicaid