Provider Demographics
NPI:1922574557
Name:FUGATE, KARRIE LYNN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:KARRIE
Middle Name:LYNN
Last Name:FUGATE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 121ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3383
Mailing Address - Country:US
Mailing Address - Phone:763-670-5369
Mailing Address - Fax:
Practice Address - Street 1:424 121ST AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3383
Practice Address - Country:US
Practice Address - Phone:763-670-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF09180754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily