Provider Demographics
NPI:1598372328
Name:FULK, ABBIE LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:LYNN
Last Name:FULK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 K ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-3312
Mailing Address - Country:US
Mailing Address - Phone:308-631-2361
Mailing Address - Fax:
Practice Address - Street 1:2855 10TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341
Practice Address - Country:US
Practice Address - Phone:308-633-1325
Practice Address - Fax:308-633-1327
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner