Individual
CAROLINE MACKENZIE FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 274-4491
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10005338A
IN
363A00000X
Physician Assistant
PA15955
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300133197
—
IN
01
—
PA15955
TEXAS PHYSICIAN ASSISTANT LICENSE NUMBER
TX
Enumeration date
10/05/2022
Last updated
08/04/2026
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