Provider Demographics
NPI:1558518274
Name:FULKERSON, NICHOLAS DAVID
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:DAVID
Last Name:FULKERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 STATE ROUTE 22 SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-9557
Mailing Address - Country:US
Mailing Address - Phone:740-333-7990
Mailing Address - Fax:
Practice Address - Street 1:1227 STATE ROUTE 22 SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-9557
Practice Address - Country:US
Practice Address - Phone:740-333-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2727237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist