Provider Demographics
NPI:1144630047
Name:FULTON, MELISSA A (CNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:FULTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 HARRISON AVE UNIT N
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-2815
Mailing Address - Country:US
Mailing Address - Phone:513-981-4242
Mailing Address - Fax:513-347-5050
Practice Address - Street 1:6507 HARRISON AVE UNIT N
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-2815
Practice Address - Country:US
Practice Address - Phone:513-981-4242
Practice Address - Fax:513-347-5050
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008621363L00000X, 363LF0000X
OHCOA.15660-NP363L00000X, 363LF0000X
OHAPRN.CNP.15660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104459Medicaid
OHP01340599OtherRR MEDICARE
KY7100307240Medicaid
KYP01377399OtherRR MEDICARE
OH0104459Medicaid
KYK140021Medicare PIN
KYK140020Medicare PIN
OHH386520Medicare PIN
KYK140022Medicare PIN