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LAKEN NICOLE FULCHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
16569 W MAIN ST, LOUISVILLE, MS 39339-2647
(662) 773-5704
(662) 773-9463
Mailing address
PO BOX 470, LOUISVILLE, MS 39339-0470
(662) 446-1972
(662) 446-1039

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R903535
MS

Other

Enumeration date
10/22/2019
Last updated
10/22/2019
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