Provider Demographics
NPI:1720356256
Name:FULKERSON, GRETCHEN L (APRN)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:FULKERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 STATE HIGHWAY 46 S STE 104
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2237
Mailing Address - Country:US
Mailing Address - Phone:830-433-7815
Mailing Address - Fax:
Practice Address - Street 1:1761 STATE HIGHWAY 46 S STE 104
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2237
Practice Address - Country:US
Practice Address - Phone:830-433-7815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1052882363LF0000X
AZAP4290208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily