Provider Demographics
NPI:1235215856
Name:FULLMER, KURT D (PA-C)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:D
Last Name:FULLMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:406 E ROWAN AVE
Mailing Address - Street 2:SUITE200
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1243
Mailing Address - Country:US
Mailing Address - Phone:509-489-4040
Mailing Address - Fax:509-489-9190
Practice Address - Street 1:406 E ROWAN AVE
Practice Address - Street 2:SUITE200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1243
Practice Address - Country:US
Practice Address - Phone:509-489-4040
Practice Address - Fax:509-489-9190
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10002270363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical