Healthcare Provider Details

I. General information

NPI: 1770423907
Provider Name (Legal Business Name): ALEXIE IZORA FUGATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 BRAND STE 200
MURPHY TX
75094-3748
US

IV. Provider business mailing address

152 BRAND STE 200
MURPHY TX
75094-3748
US

V. Phone/Fax

Practice location:
  • Phone: 469-596-6712
  • Fax: 469-596-6712
Mailing address:
  • Phone: 469-596-6712
  • Fax: 469-596-6712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: