MEDICARE: ZACHARY TYLER FULP

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	363LA2100X	Acute Care Nurse Practitioner	1038170	TX

General Provider Information

NPI Number	:	1356202865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY TYLER FULP

Provider Business Mailing Address
First Line	:	4468 MIDDLE RD
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76501-3615
Country	:	US
Telephone Number	:	512-743-3254
Fax Number	:

Provider Business Practice Location Address
First Line	:	4468 MIDDLE RD
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76501-3615
Country	:	US
Telephone Number	:	512-743-3254
Fax Number	:

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

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	03/23/2026

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