Healthcare Provider Details

I. General information

NPI: 1215859319
Provider Name (Legal Business Name): ERIN SHAY FULTINEER MAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S HEBER ST
BECKLEY WV
25801-5423
US

IV. Provider business mailing address

332 COTTAGE AVE
WESTON WV
26452-1914
US

V. Phone/Fax

Practice location:
  • Phone: 681-238-6412
  • Fax:
Mailing address:
  • Phone: 304-517-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: