Provider Demographics
NPI:1205832219
Name:FULTON, CHERYL A (DO)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:A
Last Name:FULTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S 6TH PL
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9704
Mailing Address - Country:US
Mailing Address - Phone:479-770-0700
Mailing Address - Fax:479-770-1184
Practice Address - Street 1:325 S 6TH PL
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9704
Practice Address - Country:US
Practice Address - Phone:479-770-0700
Practice Address - Fax:479-770-1184
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARI03329Medicare UPIN
AR161709003Medicaid
AR5N552Medicare PIN