Provider Demographics
NPI:1922316405
Name:FULCO, KATHERINE ANN (CNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:FULCO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 WINDERMERE PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7033
Mailing Address - Country:US
Mailing Address - Phone:678-455-2800
Mailing Address - Fax:770-888-9998
Practice Address - Street 1:3850 WINDERMERE PKWY STE 105
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7033
Practice Address - Country:US
Practice Address - Phone:678-455-2800
Practice Address - Fax:770-888-9998
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010054A363LF0000X
WV66369363LF0000X
GARN316853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300042114Medicaid
WVWV0805DMedicare PIN
WVWV0805AMedicare PIN
WVWV0805EMedicare PIN
WVWV0805BMedicare PIN
WV3810022310Medicaid
WVWV0805FMedicare PIN