Healthcare Provider Details

I. General information

NPI: 1013491984
Provider Name (Legal Business Name): LAUREL M FULGHAM AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 12/17/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UK HEALTHCARE 1000 S LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

485 N MONROE STATION DR
FAYETTEVILLE AR
72704-7036
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1000
  • Fax:
Mailing address:
  • Phone: 708-822-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3012675
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number3012675
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: