Individual
MRS. NINA MICHAEL FULKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2360 STONY BROOK DR, LOUISVILLE, KY 40220-4018
(502) 446-5462
(502) 394-3670
Mailing address
401 E CHESTNUT ST, STE #510, LOUISVILLE, KY 40202-5700
(502) 589-0802
(502) 589-0805
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3003622
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100005460
—
KY
Enumeration date
06/13/2005
Last updated
10/16/2020
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