Provider Demographics
NPI:1770997728
Name:FULKS, PENNY (MSN, APRN, NP-C)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:FULKS
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:LAINE
Other - Last Name:PASBRIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 N COLLEGE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4797
Mailing Address - Country:US
Mailing Address - Phone:636-642-1215
Mailing Address - Fax:573-234-4799
Practice Address - Street 1:910 N COLLEGE AVE STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4797
Practice Address - Country:US
Practice Address - Phone:636-642-1215
Practice Address - Fax:573-234-4799
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014018654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily