Individual
MRS. KIMBERLY D FERGUISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD-PEDIATRICS
Contact information
Practice address
3280 E LANARK DR, MERIDIAN, ID 83642-5982
(208) 377-4400
(208) 377-4416
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6501
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M9507
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010154462
BLUE SHIELD
ID
01
—
76552
BLUE CROSS
ID
05
—
807354800
—
ID
01
—
807392600
HEALTHY CONNECTIONS MCAID
ID
Enumeration date
04/19/2006
Last updated
04/25/2024
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