Healthcare Provider Details

I. General information

NPI: 1265530745
Provider Name (Legal Business Name): BARBARA DAWN FULCHER MS,RN,CS,APRN,BC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ELM AVE SW
ROANOKE VA
24016-4001
US

IV. Provider business mailing address

301 ELM AVENUE SW BLUE RIDGE BEHAVIORAL HEALTH BURRELL CENTER
ROANOKE VA
24012
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-9841
  • Fax: 540-527-2900
Mailing address:
  • Phone: 540-344-1723
  • Fax: 540-266-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024166629
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number0015000625
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: