Individual
MARY J. FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHCNP
Contact information
Practice address
5201 HARRY HINES BLVD, WISH TUBAL CLINIC, DALLAS, TX 75235-7708
(214) 590-5306
(214) 590-2798
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
594565
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144870601
—
TX
05
—
144870602
—
TX
05
—
144870603
—
TX
05
—
144870604
—
TX
05
—
144870605
—
TX
05
—
144870606
—
TX
05
—
144870607
—
TX
05
—
144870608
—
TX
05
—
144870609
—
TX
05
—
144870610
—
TX
05
—
144870611
—
TX
05
—
144870612
—
TX
01
—
8N4871
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/28/2005
Last updated
06/16/2009
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