Provider Demographics
NPI:1851032056
Name:FULLERTON, CHRISTOPHER DAMIEN (CRNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DAMIEN
Last Name:FULLERTON
Suffix:
Gender:M
Credentials:CRNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 CORNELL ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-1981
Mailing Address - Country:US
Mailing Address - Phone:717-830-8424
Mailing Address - Fax:
Practice Address - Street 1:3459 5TH AVE STE EAST412
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3236
Practice Address - Country:US
Practice Address - Phone:412-692-4200
Practice Address - Fax:412-692-4223
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025503363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty