Individual
HEATHER DANYEL FULTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9600 TWO NOTCH RD STE 5, COLUMBIA, SC 29223-1612
(769) 243-6141
(601) 914-9620
Mailing address
778 LIBERTY RD, FLOWOOD, MS 39232-9300
(769) 243-6141
(601) 914-9620
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
105463
SC
363L00000X
Nurse Practitioner
Primary
26455
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2022
Last updated
01/31/2026
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