Provider Demographics
NPI:1033731419
Name:FUGATE, KRISTEN RAE (RN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:RAE
Last Name:FUGATE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 AIRPORT GARDENS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9510
Mailing Address - Country:US
Mailing Address - Phone:606-629-3121
Mailing Address - Fax:
Practice Address - Street 1:101 AIRPORT GARDENS RD STE 200
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9510
Practice Address - Country:US
Practice Address - Phone:606-629-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1113647163WP0808X
KY3015889363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health