Provider Demographics
NPI:1356173660
Name:FERGUSON, NATHAN W (MEDIATOR (CERTIFIED))
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:W
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MEDIATOR (CERTIFIED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 W 19TH ST # 344
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3914
Mailing Address - Country:US
Mailing Address - Phone:832-713-7592
Mailing Address - Fax:
Practice Address - Street 1:448 W 19TH ST # 344
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3914
Practice Address - Country:US
Practice Address - Phone:832-713-7592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH01627842172A00000X
3747P1801X
OKT15574183700000X
FLF622639924570347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle