Individual
KAITLYN BURRICHTER FULFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 CHILDRENS WAY # 512-19A, LITTLE ROCK, AR 72202-3500
(501) 364-1874
Mailing address
1507 LINDEN AVE APT 19, JOHNSON CITY, TN 37601-7379
(615) 598-4768
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/31/2018
Last updated
03/31/2018
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