Kenyatta Pugh

Primary specialty

Home Health AideTaxonomy code 374U00000X

License

170003871 Issued in TN

Practice address

1176 Vickery LN Ste 200
Cordova, TN 38016-0631

Phone

(901) 255-4490

Fax

(901) 416-4490

NPI assigned

Sep 16, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1215543251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1176 VICKERY LN STE 200",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380160631",
            "telephone_number": "901-255-4490",
            "fax_number": "901-416-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1176 VICKERY LN STE 200",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380160631",
            "telephone_number": "901-255-4490",
            "fax_number": "901-416-4490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUGH",
        "first_name": "KENYATTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-16",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "TN",
            "license": "170003871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.jobdepotstaffing.com",
            "affiliation": "N",
            "endpointDescription": "Business website",
            "address_1": "1176 Vickery Ln Ste 200",
            "city": "Cordova",
            "state": "TN",
            "country_code": "US",
            "postal_code": "380160631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Home Health Aide in Cordova, TN
• Providers in Cordova, TN by specialty
• Home Health Aide in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.