Provider Demographics
NPI:1316144660
Name:FERGUSON, RACHAEL N (PA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:N
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 1:6151 N MAIN STREET RD
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-8189
Mailing Address - Country:US
Mailing Address - Phone:417-781-0408
Mailing Address - Fax:417-556-5357
Practice Address - Street 1:6151 N MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-8189
Practice Address - Country:US
Practice Address - Phone:417-781-0408
Practice Address - Fax:417-556-5337
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01567363A00000X
OK1626363A00000X
MO2014035677363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01408849OtherRAIL ROAD MEDICARE
MO1316144660Medicaid
KS201105830AMedicaid
MO1316144660Medicaid