Provider Demographics
NPI:1689482135
Name:FERGUSON, KADI-ANN
Entity type:Individual
Prefix:
First Name:KADI-ANN
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20057 BALLINGER WAY NE APT B611
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5578
Mailing Address - Country:US
Mailing Address - Phone:253-393-3860
Mailing Address - Fax:
Practice Address - Street 1:1615 75TH ST SW STE 210
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6293
Practice Address - Country:US
Practice Address - Phone:425-261-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60771179251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health