Provider Demographics
NPI:1174158638
Name:FERGUSON, ORELE SHANANAE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ORELE
Middle Name:SHANANAE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:SHANANAE
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:200 WHITE EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-8315
Mailing Address - Country:US
Mailing Address - Phone:580-765-2501
Mailing Address - Fax:580-765-0984
Practice Address - Street 1:200 WHITE EAGLE DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-8315
Practice Address - Country:US
Practice Address - Phone:580-765-2501
Practice Address - Fax:580-765-0984
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF02200717363L00000X
OK102530163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse