MEDICARE: D'ERICKA L FULGHAM-ARTIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024190622	VA

General Provider Information

NPI Number	:	1033943998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	D'ERICKA L FULGHAM-ARTIS

Provider Business Mailing Address
First Line	:	2800 GODWIN BLVD
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-8038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 S MIAMI BLVD STE 101
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-4928
Country	:	US
Telephone Number	:	360-383-5051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2024
Last Update Date	:	12/01/2025

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