Provider Demographics
NPI:1730449638
Name:FULBRIGHT, ANNE (MA MMS, PA-C)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:FULBRIGHT
Suffix:
Gender:
Credentials:MA MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LONG SHOALS RD STE B143
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-5544
Mailing Address - Country:US
Mailing Address - Phone:828-606-1955
Mailing Address - Fax:828-676-1445
Practice Address - Street 1:4 LONG SHOALS RD STE B143
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-5544
Practice Address - Country:US
Practice Address - Phone:828-606-1955
Practice Address - Fax:828-676-1445
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03566363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCC457BMedicare UPIN