Provider Demographics
NPI:1457694960
Name:FULTZ, ASHLEY N (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:FULTZ
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2829
Mailing Address - Country:US
Mailing Address - Phone:606-242-2077
Mailing Address - Fax:606-242-2027
Practice Address - Street 1:2010 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2829
Practice Address - Country:US
Practice Address - Phone:606-242-2077
Practice Address - Fax:606-242-2027
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily