MEDICARE: HANNAH ALLISON WATTS FULKS APRN

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	363LW0102X	Women's Health Nurse Practitioner	124248	WV

General Provider Information

NPI Number	:	1689539041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH ALLISON WATTS FULKS APRN

Provider Business Mailing Address
First Line	:	211 OAKWOOD RD
Second Line	:
City	:	CULLODEN
State	:	WV
Zip	:	25510-7595
Country	:	US
Telephone Number	:	304-389-6981
Fax Number	:

Provider Business Practice Location Address
First Line	:	3818 TEAYS VALLEY RD
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9720
Country	:	US
Telephone Number	:	304-812-4955
Fax Number	:

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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