Healthcare Provider Details

I. General information

NPI: 1225079957
Provider Name (Legal Business Name): KRISTINE D PUGH M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MISS KRISTINE D PUGH

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7225 WATSON RD
SAINT LOUIS MO
63119-4401
US

IV. Provider business mailing address

7225 WATSON RD
SAINT LOUIS MO
63119-4401
US

V. Phone/Fax

Practice location:
  • Phone: 314-752-3131
  • Fax: 314-752-3265
Mailing address:
  • Phone: 314-752-3131
  • Fax: 314-752-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number107775
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: