Healthcare Provider Details

I. General information

NPI: 1144630047
Provider Name (Legal Business Name): MELISSA A FULTON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 HARRISON AVE UNIT N
CINCINNATI OH
45247-2815
US

IV. Provider business mailing address

6507 HARRISON AVE UNIT N
CINCINNATI OH
45247-2815
US

V. Phone/Fax

Practice location:
  • Phone: 513-981-4242
  • Fax: 513-347-5050
Mailing address:
  • Phone: 513-981-4242
  • Fax: 513-347-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3008621
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.15660-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008621
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.15660-NP
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.15660
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: