Provider Demographics
NPI:1902602477
Name:FUGATE, TALITHA MARIE
Entity type:Individual
Prefix:
First Name:TALITHA
Middle Name:MARIE
Last Name:FUGATE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:TALITHA
Other - Middle Name:MARIE
Other - Last Name:CLINGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 CORNHUSKER RD
Mailing Address - Street 2:STE 105 PMB 351
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005
Mailing Address - Country:US
Mailing Address - Phone:402-214-1740
Mailing Address - Fax:
Practice Address - Street 1:1820 HILLCREST DRIVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005
Practice Address - Country:US
Practice Address - Phone:402-682-6599
Practice Address - Fax:402-682-6563
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant