MEDICARE: KAYE PALMER FULCHER MSW, LCSW

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	1041C0700X	Clinical Social Worker	C003711	NC

General Provider Information

NPI Number	:	1760548382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYE PALMER FULCHER MSW, LCSW

Provider Business Mailing Address
First Line	:	6845 FAIRVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3363
Country	:	US
Telephone Number	:	704-364-4333
Fax Number	:	704-969-1175

Provider Business Practice Location Address
First Line	:	6845 FAIRVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3363
Country	:	US
Telephone Number	:	704-364-4333
Fax Number	:	704-969-1175

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	11/22/2020

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