Provider Demographics
NPI:1336946847
Name:FERGUSON, KELSEY (APRN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 SHIRLEY JEAN LN
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76233-1521
Mailing Address - Country:US
Mailing Address - Phone:940-453-1986
Mailing Address - Fax:
Practice Address - Street 1:5012 S US HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4587
Practice Address - Country:US
Practice Address - Phone:903-416-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191895363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care