Provider Demographics
NPI:1952094294
Name:FULTON, TERESA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:FULTON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 NIGHTSTALKER WAY
Mailing Address - Street 2:
Mailing Address - City:FT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223
Mailing Address - Country:US
Mailing Address - Phone:270-461-3861
Mailing Address - Fax:270-798-1118
Practice Address - Street 1:7229 NIGHTSTALKER WAY
Practice Address - Street 2:
Practice Address - City:FT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-461-3861
Practice Address - Fax:270-798-1118
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN613887163WA2000X, 163WC0400X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management