Provider Demographics
NPI:1386778710
Name:FULKERSON, PATRICIA LINK (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LINK
Last Name:FULKERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4700
Mailing Address - Fax:502-772-8189
Practice Address - Street 1:2215 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212
Practice Address - Country:US
Practice Address - Phone:502-774-8631
Practice Address - Fax:502-778-3499
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004682A1041C0700X
KY19341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100129170Medicaid
KYP400017956Medicare PIN
KYP400017954Medicare PIN
KYP400019755Medicare PIN
KYP400017953Medicare PIN
KYP400017957Medicare PIN
KYP400017958Medicare PIN