Healthcare Provider Details

I. General information

NPI: 1316495328
Provider Name (Legal Business Name): KARLA FULTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E FORTIFICATION ST
JACKSON MS
39202-2442
US

IV. Provider business mailing address

100 WILBURN WAY
STARKVILLE MS
39759-3692
US

V. Phone/Fax

Practice location:
  • Phone: 601-354-4488
  • Fax: 601-914-1779
Mailing address:
  • Phone: 662-320-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901712
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: