Provider Demographics
NPI:1912111923
Name:FULBRIGHT-WILLIAMS, MONEKA DANIELL (MHPP)
Entity Type:Individual
Prefix:
First Name:MONEKA
Middle Name:DANIELL
Last Name:FULBRIGHT-WILLIAMS
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:MONEKA
Other - Middle Name:DANIELL
Other - Last Name:FULBRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11818
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1818
Mailing Address - Country:US
Mailing Address - Phone:479-452-6650
Mailing Address - Fax:479-452-5847
Practice Address - Street 1:3111 S 70TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5017
Practice Address - Country:US
Practice Address - Phone:479-452-6650
Practice Address - Fax:479-452-5847
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator