Provider Demographics
NPI:1417524018
Name:FULTZ, KRIS YVONNE (RN)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:YVONNE
Last Name:FULTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:IN
Mailing Address - Zip Code:47243-9714
Mailing Address - Country:US
Mailing Address - Phone:812-866-8396
Mailing Address - Fax:
Practice Address - Street 1:188 THORNTON RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:IN
Practice Address - Zip Code:47243-9714
Practice Address - Country:US
Practice Address - Phone:812-866-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28201115A364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care