Provider Demographics
NPI:1679197974
Name:FULTON, BILLI-JO (PMHNP)
Entity Type:Individual
Prefix:
First Name:BILLI-JO
Middle Name:
Last Name:FULTON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4386
Mailing Address - Country:US
Mailing Address - Phone:518-636-5284
Mailing Address - Fax:
Practice Address - Street 1:84 BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4381
Practice Address - Country:US
Practice Address - Phone:518-636-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY683327363LP0808X
NY403155363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health