MEDICARE: JESSICA SWINK FULK PA-C

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	363A00000X	Physician Assistant	0010-08139	NC

General Provider Information

NPI Number	:	1467946277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SWINK FULK PA-C

Provider Business Mailing Address
First Line	:	9930 KINCEY AVE STE 165
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-6541
Country	:	US
Telephone Number	:	704-947-5005
Fax Number	:	877-881-8455

Provider Business Practice Location Address
First Line	:	268 GILLMAN RD STE A
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-7925
Country	:	US
Telephone Number	:	704-659-7830
Fax Number	:	877-881-8455

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

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	06/14/2023

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