Healthcare Provider Details

I. General information

NPI: 1740474568
Provider Name (Legal Business Name): KRISHA CHARLENE FULCHER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 W MARC KNIGHTON CT SUITE A
LECANTO FL
34461-6300
US

IV. Provider business mailing address

2804 W MARC KNIGHTON CT SUITE A
LECANTO FL
34461-6300
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-8000
  • Fax: 352-746-8003
Mailing address:
  • Phone: 352-746-8067
  • Fax: 352-746-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: