Provider Demographics
NPI:1437644424
Name:FUGATE, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:FUGATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 LONDON MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6601
Mailing Address - Country:US
Mailing Address - Phone:606-877-2850
Mailing Address - Fax:606-877-2857
Practice Address - Street 1:272 LONDON MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6601
Practice Address - Country:US
Practice Address - Phone:606-877-2850
Practice Address - Fax:606-877-2857
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1136514163W00000X
KY3012459363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse