Provider Demographics
NPI:1811012487
Name:FULTZ, TAMARA A (MHPP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:A
Last Name:FULTZ
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 HIGHWAY 371 W
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-7598
Mailing Address - Country:US
Mailing Address - Phone:870-451-8742
Mailing Address - Fax:870-451-8752
Practice Address - Street 1:1575 HIGHWAY 371 W
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-7598
Practice Address - Country:US
Practice Address - Phone:870-451-8742
Practice Address - Fax:870-451-8752
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator