Healthcare Provider Details

I. General information

NPI: 1639669369
Provider Name (Legal Business Name): KRISTIN MARIE FULKS CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 N FRANKLIN ST
DENVER CO
80205-5437
US

IV. Provider business mailing address

13891 MONROE ST
THORNTON CO
80602-8731
US

V. Phone/Fax

Practice location:
  • Phone: 720-903-6988
  • Fax:
Mailing address:
  • Phone: 720-903-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: