Individual
KELI KAZMAR FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(812) 353-9515
Mailing address
8336 SWEETWATER DR, NINEVEH, IN 46164-9628
(317) 933-2213
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1001097A
IN
Other
Enumeration date
07/24/2009
Last updated
01/26/2021
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