Provider Demographics
NPI:1750049466
Name:PUGH, KYRA BETH
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:BETH
Last Name:PUGH
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 1:1000 E HARVEST LOOP APT 1503
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-5423
Mailing Address - Country:US
Mailing Address - Phone:509-859-2881
Mailing Address - Fax:
Practice Address - Street 1:1000 E HARVEST LOOP APT 1503
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-5423
Practice Address - Country:US
Practice Address - Phone:509-859-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86264763133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty