Provider Demographics
NPI:1386682003
Name:FULCHER, ROSS BURRUS JR (APRN)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:BURRUS
Last Name:FULCHER
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4339
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-4339
Mailing Address - Country:US
Mailing Address - Phone:843-676-0200
Mailing Address - Fax:
Practice Address - Street 1:101S RAVENEL ST 140
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2644
Practice Address - Country:US
Practice Address - Phone:843-676-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR 43406163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health