| Doctor Name: | KELLY A FERGUSON |
| NPI Number: | 1013292192 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | A.R.N.P. |
| License Number: | A-112482 |
| Business Practice Address: | 1701 W Broadway Council Bluffs, IA - 515013822 |
| Business Phone Number: | 7122565600 |
| Business Fax Number: | 7122563440 |
| Mailing Address: | 1701 W Broadway, COUNCIL BLUFFS |
| State: | IA |
| Postal Code: | 515013822 |
| Phone Number: | 7122565600 |
| Fax Number: | 7122563440 |
| NPI Enumeration Date: | 10/20/2011 |
| NPI Last Update Date: | 10/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A-112482 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |