MEDICARE: FULTON & FULTON LLC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	363LC1500X	Community Health Nurse Practitioner

General Provider Information

NPI Number	:	1790384014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULTON & FULTON LLC

Provider Business Mailing Address
First Line	:	560 W BROWN RD STE 1011
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-3222
Country	:	US
Telephone Number	:	480-509-7738
Fax Number	:	480-856-9069

Provider Business Practice Location Address
First Line	:	560 W BROWN RD STE 1011
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-3222
Country	:	US
Telephone Number	:	480-509-7738
Fax Number	:	480-856-9069

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TROY FULTON
Credential	:	PMHNP
Telephone Number	:	480-509-7738

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	07/23/2024

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Directions to “FULTON & FULTON LLC ” Practice Location

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