Provider Demographics
NPI:1164414520
Name:FULWOOD, KAREN J (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:J
Last Name:FULWOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 NEZ PERCE DR
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-4237
Mailing Address - Country:US
Mailing Address - Phone:563-495-8861
Mailing Address - Fax:843-393-6210
Practice Address - Street 1:110 CHERRY ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3904
Practice Address - Country:US
Practice Address - Phone:843-968-3395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201429363LP0808X, 363LP2300X
SC3301363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
2632023OtherUNITED HEALTHCARE
NC6005035Medicaid
SCNP2798Medicaid
NC6005035Medicaid
2806273Medicare PIN