Provider Demographics
NPI:1598136517
Name:JUGANT, CARA KYLIE (PA)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:KYLIE
Last Name:JUGANT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:KYLIE
Other - Last Name:MACLENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3450 FAIRPOINT ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1207
Mailing Address - Country:US
Mailing Address - Phone:801-928-0133
Mailing Address - Fax:
Practice Address - Street 1:3450 FAIRPOINT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1207
Practice Address - Country:US
Practice Address - Phone:801-928-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant