Provider Demographics
NPI:1679836118
Name:FULTZ, KATIE JEAN (PA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JEAN
Last Name:FULTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:222 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-4231
Mailing Address - Country:US
Mailing Address - Phone:513-475-8690
Mailing Address - Fax:513-475-7593
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-8690
Practice Address - Fax:513-475-7593
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant