Provider Demographics
NPI:1457171316
Name:FUGATE, KYLE DEWAYNE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DEWAYNE
Last Name:FUGATE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 S CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3625
Mailing Address - Country:US
Mailing Address - Phone:918-876-4048
Mailing Address - Fax:
Practice Address - Street 1:504 S CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3625
Practice Address - Country:US
Practice Address - Phone:918-876-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist