Provider Demographics
NPI:1245736685
Name:PUGH, KATHLEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PUGH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 W BYPASS
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-4731
Mailing Address - Country:US
Mailing Address - Phone:334-222-3555
Mailing Address - Fax:334-427-9522
Practice Address - Street 1:614 W BYPASS
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-4731
Practice Address - Country:US
Practice Address - Phone:334-222-3555
Practice Address - Fax:334-427-9522
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily