Basic Information
| Provider Information | |||||||||
| NPI: | 1245706001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUGSLEY | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | XAVIER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2905 3RD AVE SE | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574015420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056264300 | ||||||||
| FaxNumber: | 6056264301 | ||||||||
| Practice Location | |||||||||
| Address1: | 3015 3RD AVE SE | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574015418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052265500 | ||||||||
| FaxNumber: | 6052265601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2018 | ||||||||
| LastUpdateDate: | 06/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CP001483 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | CP001483 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.