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NPI Code Detail

MEDICARE: HEATHER DANYEL FULTS NP

MEDICARE: HEATHER DANYEL FULTS NP
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
1363L00000XNurse Practitioner26455SC

General Provider Information

NPI Number : 1659014751
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER DANYEL FULTS NP
Provider Business Mailing Address
First Line : 778 LIBERTY RD
Second Line :
City : FLOWOOD
State : MS
Zip : 39232-9300
Country : US
Telephone Number : 769-243-6141
Fax Number : 601-914-9620
Provider Business Practice Location Address
First Line : 9600 TWO NOTCH RD STE 5
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-1612
Country : US
Telephone Number : 769-243-6141
Fax Number : 601-914-9620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2022
Last Update Date : 01/31/2026

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Directions to “ HEATHER DANYEL FULTS NP” Practice Location

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