Provider Demographics
NPI:1780859546
Name:FUGATE, PATRICIA JEAN
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEAN
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 1:441 GORMAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2315
Mailing Address - Country:US
Mailing Address - Phone:606-439-2361
Mailing Address - Fax:606-439-0870
Practice Address - Street 1:441 GORMAN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2315
Practice Address - Country:US
Practice Address - Phone:606-439-2361
Practice Address - Fax:606-439-0870
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1077115163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health