Individual
LISA FULKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3200 FALLING SPRINGS RD, BONNIEVILLE, KY 42713-7406
(516) 551-0120
Mailing address
3200 FALLING SPRINGS RD, BONNIEVILLE, KY 42713-7406
(516) 551-0120
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
201195751
KY
Other
Enumeration date
07/11/2023
Last updated
07/11/2023
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