Provider Demographics
NPI:1467946277
Name:FULK, JESSICA SWINK (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SWINK
Last Name:FULK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEANNE
Other - Last Name:SWINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9930 KINCEY AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6541
Mailing Address - Country:US
Mailing Address - Phone:704-947-5005
Mailing Address - Fax:877-881-8455
Practice Address - Street 1:268 GILLMAN RD STE A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7925
Practice Address - Country:US
Practice Address - Phone:704-659-7830
Practice Address - Fax:877-881-8455
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant