Individual
LISA FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7607 DIXIE HWY, FLORENCE, KY 41042
(859) 655-6100
Mailing address
215 E 11TH ST, NEWPORT, KY 41071-2203
(859) 655-6100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02519
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64025190
—
KY
Enumeration date
09/08/2006
Last updated
04/03/2021
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