Individual
JEFFERY FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
7150 CLEARVISTA DR, INDIANAPOLIS, IN 46256-1695
(317) 621-5890
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7547
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28188327A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28188327A
IN
367500000X
Certified Registered Nurse Anesthetist
287009
OH
367500000X
Certified Registered Nurse Anesthetist
CERT #78435
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000947187
ANTHEM PROVIDER NUMBER
IN
05
—
200914780
—
IN
Enumeration date
11/13/2007
Last updated
12/20/2022
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