Provider Demographics
NPI:1033790332
Name:FUGARINO, KIM C (AGNP-C)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:C
Last Name:FUGARINO
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:C
Other - Last Name:CORTEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:42388 PELICAN PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2412
Mailing Address - Country:US
Mailing Address - Phone:855-426-2519
Mailing Address - Fax:
Practice Address - Street 1:42388 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2412
Practice Address - Country:US
Practice Address - Phone:985-542-6251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218007363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology