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General NPI Number Information
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NPI Number | 1720549934
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Entity Type | Individual
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Provider Name | TYLER CHRYSTINE FUGERE MD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 3 MEDICAL PARK DR STE 202
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City | BENTON
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State | AR
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Zip | 72015-3700
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Country | US
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Telephone | 501-507-6035
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Fax | 501-776-9677
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Provider Business Mailing Address
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Address Line | PO BOX 749495
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City | ATLANTA
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State | GA
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Zip | 30374-9495
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Country | US
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Telephone | 855-963-2100
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Fax | 813-321-1296
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | E-15619
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-15619
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License Number State | AR
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