Individual
MRS. KIMOTHY ANN FULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN NP C
Contact information
Practice address
11020 STATE ROUTE 250, LAWRENCEVILLE, IL 62439-3379
(618) 943-2609
(618) 943-6409
Mailing address
PO BOX 516, LAWRENCEVILLE, IL 62439-0516
(618) 943-2609
(618) 943-6409
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209005713
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109800
HEALTH ALLIANCE INS
IL
01
—
1729885
FIRST HEALTH
—
05
—
376006178007
—
IL
01
—
5132004
BCBS
IL
01
—
731354
HEALTH LINK INS
IL
01
—
838915
UNITED HEALTHCARE
—
Enumeration date
07/07/2006
Last updated
09/09/2019
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