1962628321 NPI number — MRS. SHARON MEGAN FULTON NON HEALTH AIDE

Table of content: MRS. SHARON MEGAN FULTON NON HEALTH AIDE (NPI 1962628321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962628321 NPI number — MRS. SHARON MEGAN FULTON NON HEALTH AIDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FULTON
Provider First Name:
SHARON
Provider Middle Name:
MEGAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NON HEALTH AIDE
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:
1962628321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6456 STATE ROUTE 784
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH SHORE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41175-8621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-932-6246
Provider Business Mailing Address Fax Number:
606-932-4305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6456 STATE ROUTE 784
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH SHORE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41175-8621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-932-6246
Provider Business Practice Location Address Fax Number:
606-932-4305
Provider Enumeration Date:
04/17/2007

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: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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