Provider Demographics
NPI:1285602011
Name:FUGATE, FAIRLENA KAYE (DC)
Entity type:Individual
Prefix:DR
First Name:FAIRLENA
Middle Name:KAYE
Last Name:FUGATE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9483
Mailing Address - Country:US
Mailing Address - Phone:606-439-3399
Mailing Address - Fax:606-487-9280
Practice Address - Street 1:100 VETERANS DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9483
Practice Address - Country:US
Practice Address - Phone:606-439-3399
Practice Address - Fax:606-487-9280
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8163111N00000X
KY4580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000412Medicaid
KY000000175042OtherANTHEM BC/BS PIN NUMBER
KY350052859Medicare PIN
KY000000175042OtherANTHEM BC/BS PIN NUMBER
KY85000412Medicaid