Provider Demographics
NPI:1497701387
Name:FULTON, PRESTINE WELLS (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:PRESTINE
Middle Name:WELLS
Last Name:FULTON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MRS
Other - First Name:MARGARET
Other - Middle Name:PRESTINE
Other - Last Name:FULTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD
Mailing Address - Street 1:7805 LEGEND AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1761
Mailing Address - Country:US
Mailing Address - Phone:806-353-4949
Mailing Address - Fax:806-358-4498
Practice Address - Street 1:6010 AMARILLO BLVD WEST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-355-9703
Practice Address - Fax:806-468-1502
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX424428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered