Individual
SCOTT LEE FULKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
315 E WALNUT ST, ELLINGTON, MO 63638-7943
(573) 663-2644
Mailing address
315 E WALNUT ST, ELLINGTON, MO 63638-7943
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/03/2025
Last updated
06/03/2025
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