Healthcare Provider Details

I. General information

NPI: 1437111549
Provider Name (Legal Business Name): PAULA KATHERINE FULTON NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 W CLINCH AVE
KNOXVILLE TN
37916-2301
US

IV. Provider business mailing address

12111 LEATHERWOOD LN
KNOXVILLE TN
37934-1517
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-8141
  • Fax: 865-541-8649
Mailing address:
  • Phone: 865-966-9535
  • Fax: 865-541-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN0000053323
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: