Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP016263 | PA |
N | 363LA2100X | Nurse Practitioner - Acute Care | SP016263 | PA |
N | 363LG0600X | Nurse Practitioner - Gerontology | SP016263 | PA |
NPI | 1083067425 |
---|---|
Provider Name | Kristen E Fulton |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2016 |
Last Update Date | 07/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103135760 | (05) | PA |
523514 | MEDICARE (01) | PA |