Healthcare Provider Details

I. General information

NPI: 1194142992
Provider Name (Legal Business Name): PATSY FULGHUM BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 W EVANS ST
FLORENCE SC
29501-3331
US

IV. Provider business mailing address

1705 W EVANS ST
FLORENCE SC
29501-3331
US

V. Phone/Fax

Practice location:
  • Phone: 843-661-4762
  • Fax:
Mailing address:
  • Phone: 843-661-4762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number14381
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number14381
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number14381
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number14381
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number14381
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: