Individual
KENYATTA PUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1176 VICKERY LN STE 200, CORDOVA, TN 38016-0631
(901) 255-4490
(901) 416-4490
Mailing address
1176 VICKERY LN STE 200, CORDOVA, TN 38016-0631
(901) 255-4490
(901) 416-4490
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
170003871
TN
Other
Enumeration date
09/16/2020
Last updated
09/16/2020
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