Individual
JENNIFER MICKEY FULP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1191 SLATE RD, KING, NC 27021-8021
(843) 315-5234
Mailing address
1191 SLATE RD, KING, NC 27021-8021
(843) 315-5234
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
175104
NC
Other
Enumeration date
03/14/2021
Last updated
03/14/2021
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