Healthcare Provider Details

I. General information

NPI: 1558385500
Provider Name (Legal Business Name): SHARON EMELIA WELLS FULKERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON EMELIA WELLS MD

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

IV. Provider business mailing address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-6500
  • Fax: 260-407-8004
Mailing address:
  • Phone: 606-783-6500
  • Fax: 260-407-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number20303
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20303
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: