Provider Demographics
NPI:1962289793
Name:FERBERT, MISTY DAWN (FNP)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:FERBERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 OLD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-5916
Mailing Address - Country:US
Mailing Address - Phone:912-663-5251
Mailing Address - Fax:
Practice Address - Street 1:119 CHIMNEY RD
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5541
Practice Address - Country:US
Practice Address - Phone:912-295-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN300064363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner