Provider Demographics
NPI:1144466749
Name:FERGUSON, CHRISTINA KAY (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:KAY
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:KAY
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-2402
Mailing Address - Country:US
Mailing Address - Phone:660-359-5621
Mailing Address - Fax:660-359-3541
Practice Address - Street 1:701 E 1ST ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2402
Practice Address - Country:US
Practice Address - Phone:660-359-5621
Practice Address - Fax:660-359-3541
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029878133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered