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General NPI Number Information
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NPI Number | 1164164695
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Entity Type | Individual
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Provider Name | JESSICA MICHELLE FULKERSON MD
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Gender | Female
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 550 S JACKSON ST FL 3
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City | LOUISVILLE
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State | KY
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Zip | 40202-1622
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Country | US
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Telephone | 502-852-5666
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Fax | 502-852-8980
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE FL 2
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-2704
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Fax | 410-500-4266
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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