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Individual

MR. KEITH QUENTIN FULTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
8885 PATCHES CV, BARTLETT, TN 38133-3801
(901) 619-0310
Mailing address
8885 PATCHES CV, BARTLETT, TN 38133-3801
(901) 619-0310

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
81-0068
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
9001
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3155973
BLUE CROSS
TN
05
3600621
TN
Enumeration date
03/05/2006
Last updated
01/12/2008
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