Individual
MCKENNA COLLIER FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 440-3532
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 672-2691
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA223194
OR
363AM0700X
Medical Physician Assistant
13768000-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/28/2021
Last updated
03/17/2025
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