Healthcare Provider Details

I. General information

NPI: 1689539041
Provider Name (Legal Business Name): HANNAH ALLISON WATTS FULKS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3818 TEAYS VALLEY RD
HURRICANE WV
25526-9720
US

IV. Provider business mailing address

211 OAKWOOD RD
CULLODEN WV
25510-7595
US

V. Phone/Fax

Practice location:
  • Phone: 304-812-4955
  • Fax:
Mailing address:
  • Phone: 304-389-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number124248
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: