1437115201 NPI number — DR. BETTY LOUISE FUGETT-ORANGE DO

Table of content: DR. BETTY LOUISE FUGETT-ORANGE DO (NPI 1437115201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437115201 NPI number — DR. BETTY LOUISE FUGETT-ORANGE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUGETT-ORANGE
Provider First Name:
BETTY
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FUGETT
Provider Other First Name:
BETTY
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1437115201
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1466
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAGOULD
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72451-1466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-239-8307
Provider Business Mailing Address Fax Number:
870-239-8301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W KINGSHIGHWAY STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAGOULD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-239-8307
Provider Business Practice Location Address Fax Number:
870-239-8301
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  R6P34 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: E0444 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200367760 . This is a "TRICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 127460003 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04080021200 . This is a "QUAL CHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 152158004 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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