Provider Demographics
NPI:1306115514
Name:BUGG, JOHN WESLEY (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WESLEY
Last Name:BUGG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2507 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-3124
Mailing Address - Country:US
Mailing Address - Phone:270-442-8228
Mailing Address - Fax:270-442-9566
Practice Address - Street 1:2507 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-3124
Practice Address - Country:US
Practice Address - Phone:270-442-8228
Practice Address - Fax:270-442-9566
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51276367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered