Provider Demographics
NPI:1528773181
Name:FULK, WHITNEY ROBERTS (FNP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ROBERTS
Last Name:FULK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 UNIVERSITY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8315
Mailing Address - Country:US
Mailing Address - Phone:336-283-2720
Mailing Address - Fax:
Practice Address - Street 1:730 HIGHLAND OAKS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7154
Practice Address - Country:US
Practice Address - Phone:336-646-7323
Practice Address - Fax:336-646-7787
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFULK-LRQ8E363LF0000X
NC5017521363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily