Provider Demographics
NPI:1811028087
Name:FULK, KURT B (C PED, BOC-O, CO)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:B
Last Name:FULK
Suffix:
Gender:M
Credentials:C PED, BOC-O, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 SOMMER LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65610-8324
Mailing Address - Country:US
Mailing Address - Phone:417-744-4152
Mailing Address - Fax:
Practice Address - Street 1:2100 S BRENTWOOD BLVD STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2534
Practice Address - Country:US
Practice Address - Phone:417-888-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier