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General NPI Number Information
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NPI Number | 1154145837
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Entity Type | Individual
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Provider Name | PAMELA RENAE FUGATE APRN
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Gender | Female
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 305 ESTILL ST
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City | BEREA
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State | KY
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Zip | 40403-1742
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Country | US
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Telephone | 859-985-1415
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Fax |
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Provider Business Mailing Address
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Address Line | 1078 MAPLE GROVE SCHOOL RD
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City | LONDON
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State | KY
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Zip | 40744-8931
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Country | US
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Telephone | 606-260-0174
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4029192
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License Number State | KY
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