Provider Demographics
NPI:1205285566
Name:FUGERE, KELLIE
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:FUGERE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:CANGELOSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLMSW
Mailing Address - Street 1:1701 CENTERVIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4312
Mailing Address - Country:US
Mailing Address - Phone:501-644-9744
Mailing Address - Fax:
Practice Address - Street 1:1701 CENTERVIEW DR STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4312
Practice Address - Country:US
Practice Address - Phone:501-644-9744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7926-C1041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker