Healthcare Provider Details

I. General information

NPI: 1871561548
Provider Name (Legal Business Name): SHARON ANNE PUGH PHD, MP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 PHEASANT RUN
ALEXANDRIA LA
71303-2450
US

IV. Provider business mailing address

5016 PHEASANT RUN
ALEXANDRIA LA
71303-2450
US

V. Phone/Fax

Practice location:
  • Phone: 318-308-1319
  • Fax:
Mailing address:
  • Phone: 318-308-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number906
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP0906
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMPAP000034
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: