Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 3012675 | KY |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 3012675 | KY |
NPI | 1013491984 |
---|---|
Provider Name | Dr. Laurel M Fulgham |
First Address | Fayetteville, AR 72704-7036 |
Second Address | Lexington, KY 40536-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2018 |
Last Update Date | 17/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2017014796 | AMERICAN NURSE CREDENTIALING CENTER (01) | |
3012675 | KENTUCKY STATE BOARD OF NURSING (01) | KY |