Provider Demographics
NPI:1730706888
Name:FULGHUM, BRITTANY WOOTEN (AGNP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:WOOTEN
Last Name:FULGHUM
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7522 BENCHMARK RD
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542-7813
Mailing Address - Country:US
Mailing Address - Phone:252-230-4146
Mailing Address - Fax:
Practice Address - Street 1:2605 FOREST HILLS RD SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4448
Practice Address - Country:US
Practice Address - Phone:252-243-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013282363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner