Provider Demographics
NPI:1417946567
Name:NUGENT, KENNETH MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MICHAEL
Last Name:NUGENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-3150
Mailing Address - Fax:806-743-3168
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-9410
Practice Address - Country:US
Practice Address - Phone:806-743-3150
Practice Address - Fax:806-743-3168
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7699207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU4765Medicaid
TX120541100OtherFIRSTCARE COMMERCIAL
NMA035OtherTRIWEST
NM43974OtherPRESBYTERIAN COMMERCIAL
TX85E051OtherBC/BS
TX120541101Medicaid
TX136092706Medicaid
TXM0057696OtherDPS
OK100158220AMedicaid
TX80767ZOtherHMO BLUE
TX136092701Medicaid
NM43974Medicaid
TX136092701Medicaid
TXB25203Medicare UPIN
TX120541101Medicaid