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General NPI Number Information
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NPI Number | 1841066362
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Entity Type | Organization
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Legal Business Name | OPTIMAL MAN, PLLC
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 1270 25TH STREET PL SE STE 1
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City | HICKORY
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State | NC
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Zip | 28602-9657
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Country | US
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Telephone | 828-220-3190
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 25TH STREET PL SE STE 1
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City | HICKORY
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State | NC
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Zip | 28602-9657
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Country | US
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Telephone | 828-220-3190
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRYAN FULKERSIN
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Credential | FNP-C
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Telephone | 910-228-7538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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