Individual
GARY FULKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3001 N MAIN ST STE 1C, PRESCOTT VALLEY, AZ 86314-1215
(928) 458-5470
(928) 458-5979
Mailing address
3001 N MAIN ST STE 1C, PRESCOTT VALLEY, AZ 86314-1215
(928) 458-5470
(928) 458-5979
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7347
AZ
363AM0700X
Medical Physician Assistant
103161-1206
UT
363AM0700X
Medical Physician Assistant
PA1673
NV
Other
Enumeration date
12/19/2005
Last updated
03/27/2019
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