Provider Demographics
NPI:1184452955
Name:FULTON & WILSON
Entity type:Organization
Organization Name:FULTON & WILSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:520-614-8645
Mailing Address - Street 1:560 W BROWN RD STE 1011
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3222
Mailing Address - Country:US
Mailing Address - Phone:520-614-8645
Mailing Address - Fax:520-277-7480
Practice Address - Street 1:560 W BROWN RD STE 1011
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3222
Practice Address - Country:US
Practice Address - Phone:520-614-8645
Practice Address - Fax:520-277-7480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULTON & WILSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty