Individual
ASHLEY FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2502 E EMPIRE ST, BLOOMINGTON, IL 61704-3738
(217) 366-4407
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3981
(217) 366-4407
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
209.016909
IL
363L00000X
Nurse Practitioner
Primary
277002498
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209.016909
ILLINOIS LICENSE
IL
Enumeration date
01/22/2018
Last updated
01/15/2025
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