Individual
ELLIE FULGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2607 MAIN ST, BENTON, KY 42025-7601
(731) 394-1145
Mailing address
4229 US HIGHWAY 68 W, BENTON, KY 42025-6636
(270) 205-5885
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4001423
KY
Other
Enumeration date
07/17/2023
Last updated
09/01/2023
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