Individual
KRYSTAL ALLENE FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1701 LACEY ST, CAPE GIRARDEAU, MO 63701
(870) 866-5092
Mailing address
PO BOX 1427, MONTICELLO, AR 71657-1427
(573) 334-4822
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2019011936
MO
163W00000X
Registered Nurse
208759
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
20180271114
MO
367500000X
Certified Registered Nurse Anesthetist
223952
AR
Other
Enumeration date
07/18/2018
Last updated
05/03/2023
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