Provider Demographics
NPI:1285780684
Name:FULKERSON, KIMBERLY BEAMAN (MED,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BEAMAN
Last Name:FULKERSON
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 N ELM ST STE E
Mailing Address - Street 2:LING & KERR THERAPY SERVICES
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2776
Mailing Address - Country:US
Mailing Address - Phone:336-370-4070
Mailing Address - Fax:336-370-9008
Practice Address - Street 1:3816 N ELM ST STE E
Practice Address - Street 2:LING & KERR THERAPY SERVICES
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2776
Practice Address - Country:US
Practice Address - Phone:336-370-4070
Practice Address - Fax:336-370-9008
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD0214OtherMEDCOST
NC135TXOtherBCBS
NC7412059Medicaid