Individual
KIRK A FOUGNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4331 CHURCHMAN AVE, SUITE 101, LOUISVILLE, KY 40215-1164
(502) 364-0902
(502) 364-0099
Mailing address
4331 CHURCHMAN AVE, SUITE 101, LOUISVILLE, KY 40215-1164
(502) 364-0902
(502) 364-0099
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA582
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50019798
PASSPORT HEALTH PLAN
KY
05
—
95001475
—
KY
Enumeration date
07/18/2005
Last updated
10/19/2015
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