Provider Demographics
NPI:1184634453
Name:FULTON, CATHY RUTH (ANP-BC, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:RUTH
Last Name:FULTON
Suffix:
Gender:F
Credentials:ANP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N EAGLESON AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47405-3190
Mailing Address - Country:US
Mailing Address - Phone:812-855-6511
Mailing Address - Fax:812-855-4628
Practice Address - Street 1:600 N EAGLESON AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-3190
Practice Address - Country:US
Practice Address - Phone:812-855-6511
Practice Address - Fax:812-855-4628
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000609363LA2200X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health