Provider Demographics
NPI:1003428293
Name:FULKS, KASHARI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:KASHARI
Middle Name:
Last Name:FULKS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 BOWLINE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3103
Mailing Address - Country:US
Mailing Address - Phone:704-200-3450
Mailing Address - Fax:704-275-0771
Practice Address - Street 1:710 JULIAN RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-9079
Practice Address - Country:US
Practice Address - Phone:470-377-1083
Practice Address - Fax:704-275-0771
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF05200690363L00000X, 363LA2100X
NC5013483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care