Healthcare Provider Details

I. General information

NPI: 1184510398
Provider Name (Legal Business Name): GRACE ANN FULTON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 GLENWOOD DR STE E788
CHATTANOOGA TN
37404-1177
US

IV. Provider business mailing address

725 GLENWOOD DR STE E788
CHATTANOOGA TN
37404-1177
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-3940
  • Fax: 423-495-3949
Mailing address:
  • Phone: 423-495-3940
  • Fax: 423-495-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number39884
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: