Healthcare Provider Details

I. General information

NPI: 1003444183
Provider Name (Legal Business Name): WHITNEY PUGH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 8TH ST STE 203E
MURRAY KY
42071-2400
US

IV. Provider business mailing address

300 S 8TH ST STE 480W
MURRAY KY
42071-2403
US

V. Phone/Fax

Practice location:
  • Phone: 270-762-1562
  • Fax: 270-752-2864
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4640
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4640
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2893
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: