Provider Demographics
NPI:1982004099
Name:FULGHUM, KIMBERLY (RN,CNOR, RNFA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FULGHUM
Suffix:
Gender:F
Credentials:RN,CNOR, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19406 TEXAS LAUREL TRL
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3309
Mailing Address - Country:US
Mailing Address - Phone:832-547-5491
Mailing Address - Fax:
Practice Address - Street 1:19406 TEXAS LAUREL TRL
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346
Practice Address - Country:US
Practice Address - Phone:832-547-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX812064163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant