Most Relevant Information
Provider Data
| NPI Number: | 1003445594 |
| Provider Name: | KELLY KUGACH |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/06/2020 |
| Last Updated: | 06/09/2023 |
Provider Practice Location
3 RIVERSIDE CIR
ROANOKE
VA
240164955
Practice Location Phone/Fax
| Phone: | 5405106200 |
| Fax: |
Provider Mailing Location
213 S JEFFERSON ST STE 1006
ROANOKE
VA
240111713
Provider Mailing Phone/Fax
| Phone: | 5402245352 |
| Fax: |