Healthcare Provider Details

I. General information

NPI: 1821519943
Provider Name (Legal Business Name): JUDITH ANN FULTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH ANN FULTON FNP

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WAYNE FRYE DR
MANCHESTER OH
45144-9314
US

IV. Provider business mailing address

14575 STATE ROUTE 41
WEST UNION OH
45693-9744
US

V. Phone/Fax

Practice location:
  • Phone: 937-549-1270
  • Fax: 937-549-1286
Mailing address:
  • Phone: 937-544-2269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020752
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: