Provider Demographics
NPI:1578843777
Name:FUGATE, JEFFREY (APRN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:FUGATE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 TERRACE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-7882
Mailing Address - Country:US
Mailing Address - Phone:606-436-0711
Mailing Address - Fax:606-436-0848
Practice Address - Street 1:311 ROY CAMPBELL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9486
Practice Address - Country:US
Practice Address - Phone:606-487-7383
Practice Address - Fax:606-487-8374
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3007083OtherLICENSE NUMBER