Provider Demographics
NPI:1386754687
Name:FERGUSON, SALLY A (RN)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RN
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 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:RR 5 BOX 800
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:KY
Practice Address - Zip Code:41171-9200
Practice Address - Country:US
Practice Address - Phone:606-738-6163
Practice Address - Fax:606-738-5030
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1073883163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000354319OtherANTHEM BCBS
KY30610026Medicaid
OH$$$$$$$$$-00OtherCAREWORKS - OHIO WORKERS' COMP