Provider Demographics
NPI:1134982960
Name:FULGHAM, KATHRYN DIANE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:DIANE
Last Name:FULGHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9666 ABBEYSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:CONCORD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6552
Mailing Address - Country:US
Mailing Address - Phone:216-269-4478
Mailing Address - Fax:
Practice Address - Street 1:9666 ABBEYSHIRE WAY
Practice Address - Street 2:
Practice Address - City:CONCORD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44060-6552
Practice Address - Country:US
Practice Address - Phone:216-269-4478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.139269.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse