Provider Demographics
NPI:1770456881
Name:FERGUS, EMMA KAYE (APRN)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:KAYE
Last Name:FERGUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:45381-1210
Mailing Address - Country:US
Mailing Address - Phone:937-733-3513
Mailing Address - Fax:
Practice Address - Street 1:3038 OLIVE RD
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2640
Practice Address - Country:US
Practice Address - Phone:937-208-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0040419363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care