Provider Demographics
NPI:1336252154
Name:FULTON, CAROLYN N (LSA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:N
Last Name:FULTON
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5707
Mailing Address - Country:US
Mailing Address - Phone:254-654-0404
Mailing Address - Fax:
Practice Address - Street 1:4907 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5707
Practice Address - Country:US
Practice Address - Phone:254-654-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00205246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant