1598372328 NPI number — ABBIE LYNN FULK APRN

Table of content: ABBIE LYNN FULK APRN (NPI 1598372328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598372328 NPI number — ABBIE LYNN FULK APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FULK
Provider First Name:
ABBIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598372328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
635 K ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERING
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69341-3312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-631-2361
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 10TH STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GERING
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-633-1325
Provider Business Practice Location Address Fax Number:
308-633-1327
Provider Enumeration Date:
09/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  113316 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com