MEDICARE: JAMA L. FULLERTON SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP#1798	AR

General Provider Information

NPI Number	:	1134340193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMA L. FULLERTON SLP

Provider Business Mailing Address
First Line	:	105 RIVER OAKS CT
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-4532
Country	:	US
Telephone Number	:	501-305-3635
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 RIVER OAKS CT
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-4532
Country	:	US
Telephone Number	:	501-305-3635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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Directions to “ JAMA L. FULLERTON SLP” Practice Location

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