Kimberly Y. Ferguson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110003173 Issued in VA

Practice address

321C Poplar Dr
Petersburg, VA 23805-9306

Phone

(804) 733-5591

Fax

(804) 733-3506

NPI assigned

Oct 27, 2009

Last updated

Mar 28, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Y. Tannor Former name

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central Virginia Health Services Inc

  dba CVHS Charlottesville

  • Federally Qualified Health Center (FQHC)
  • Charlottesville, VA
  • NPI 1548632508
  Medicare reassignment NPD
• Central Virginia Health Services Inc

  dba CVHS Downtown Petersburg

  • Federally Qualified Health Center (FQHC)
  • Petersburg, VA
  • NPI 1134258601
  Medicare reassignment
• Central Virginia Health Services Inc

  dba CVHS Charles City

  • Federally Qualified Health Center (FQHC)
  • Charles City, VA
  • NPI 1518095280
  NPD
• Central Virginia Health Services Inc

  dba CVHS Blue Devils Health Center

  • Federally Qualified Health Center (FQHC)
  • Hopewell, VA
  • NPI 1972264869
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522195200000",
    "number": "1578899456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321C POPLAR DR",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059306",
            "telephone_number": "804-733-5591",
            "fax_number": "804-733-3506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321C POPLAR DR",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059306",
            "telephone_number": "804-733-5591",
            "fax_number": "804-733-3506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1260 Temple Ave",
            "address_purpose": "LOCATION",
            "city": "Colonial Heights",
            "state": "VA",
            "postal_code": "238342984",
            "country_code": "US",
            "telephone_number": "804-518-2597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "KIMBERLY",
        "middle_name": "Y.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-27",
        "last_updated": "2018-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110003173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "TANNOR",
            "middle_name": "Y.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kayla Lynn Farnham, CTRS
• Gabrielle Lynn Farrar, NP
• Nadeem A Faruqi, MD
• Federal Bureau Prisons, FCC Petersburg
• Felts Drug Store Inc.
• Jennifer Latasha Fields, FNP
• Sheldon P Fineman, MD
• First Choice Non Emergency Medical Transport
• First Step Service LLC
• Douglas Powell Fisher Jr., OPTICIAN

• Physician Assistant in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.