Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3016863 | KY |
NPI | 1003579681 |
---|---|
Provider Name | Shayla Fulton |
First Address | West Somerset, KY 42564-3044 |
Second Address | Somerset, KY 42501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2021 |
Last Update Date | 20/10/2021 |