Basic Information
| Provider Information | |||||||||
| NPI: | 1134503899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | CASSONDRA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CFRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 SAUNDERSVILLE RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154423517 | ||||||||
| FaxNumber: | 8555404722 | ||||||||
| Practice Location | |||||||||
| Address1: | 6400 E BROAD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147790381 | ||||||||
| FaxNumber: | 6146268308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2015 | ||||||||
| LastUpdateDate: | 08/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 334444 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | COA 17588- NPC | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 208VP0000X | COA 17588 NP | OH | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.