Healthcare Provider Details

I. General information

NPI: 1447241146
Provider Name (Legal Business Name): BARBARA C FULTON A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W SCENIC RIVERS BLVD
SALEM MO
65560-2840
US

IV. Provider business mailing address

1050 W 10TH ST ATTN: EXECUTIVE DIRECTOR OF PHYSICIAN CLINICS
ROLLA MO
65401
US

V. Phone/Fax

Practice location:
  • Phone: 573-729-5533
  • Fax: 573-202-2466
Mailing address:
  • Phone: 573-364-9000
  • Fax: 573-426-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2000146655
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: