Healthcare Provider Details

I. General information

NPI: 1710934526
Provider Name (Legal Business Name): KAREN FULGHAM ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 UNITED DR STE 120A
CONWAY AR
72032-7810
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-6720
  • Fax: 501-358-6726
Mailing address:
  • Phone: 501-358-6720
  • Fax: 501-358-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01709
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: