Provider Demographics
NPI:1356756092
Name:FULGHAM, WHITNEI S (NP)
Entity type:Individual
Prefix:MRS
First Name:WHITNEI
Middle Name:S
Last Name:FULGHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WHITNEI
Other - Middle Name:LATYRCE
Other - Last Name:SAUNDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2111 GENTRY ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3420
Mailing Address - Country:US
Mailing Address - Phone:757-572-7901
Mailing Address - Fax:
Practice Address - Street 1:2111 GENTRY ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3420
Practice Address - Country:US
Practice Address - Phone:757-572-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171700363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily