Provider Demographics
NPI:1811184609
Name:FUGATE, STEPHANIE J (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:FUGATE
Suffix:
Gender:F
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:UK DIV OF PULMONARY CRITICAL CARE
Mailing Address - Street 2:740 S. LIMESTONE, L543 KY CLINIC
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-5045
Mailing Address - Fax:859-257-2418
Practice Address - Street 1:UK DIV OF PULMONARY CRITICAL CARE
Practice Address - Street 2:800 ROSE STREET
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-5045
Practice Address - Fax:859-257-2418
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN335292363L00000X
KY3006010363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2762005Medicaid
OHFUNP81061Medicare PIN