Provider Demographics
NPI:1306097761
Name:FUGATE, LORI ANN (APRN)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:FUGATE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:CLEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1306 VERSAILLES RD
Mailing Address - Street 2:120
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1796
Mailing Address - Country:US
Mailing Address - Phone:859-259-2635
Mailing Address - Fax:859-254-7874
Practice Address - Street 1:317 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-1323
Practice Address - Country:US
Practice Address - Phone:859-858-0339
Practice Address - Fax:859-858-0341
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005740363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100176280Medicaid
KY7100176280Medicaid