Healthcare Provider Details

I. General information

NPI: 1124628110
Provider Name (Legal Business Name): KATHRYN MAY FULMER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N MULDOON RD
ANCHORAGE AK
99504-6104
US

IV. Provider business mailing address

3001 C ST
ANCHORAGE AK
99503-3913
US

V. Phone/Fax

Practice location:
  • Phone: 907-257-4854
  • Fax:
Mailing address:
  • Phone: 907-201-5647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number201593
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number163945
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: