Provider Demographics
NPI:1386883890
Name:PURCIFUL, FRANKLIN FOREST (PA)
Entity type:Individual
Prefix:MR
First Name:FRANKLIN
Middle Name:FOREST
Last Name:PURCIFUL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N BELL ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-3072
Mailing Address - Country:US
Mailing Address - Phone:765-456-7330
Mailing Address - Fax:765-456-2018
Practice Address - Street 1:620 N BELL ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-3072
Practice Address - Country:US
Practice Address - Phone:765-456-7330
Practice Address - Fax:765-456-2018
Is Sole Proprietor?:No
Enumeration Date:2009-02-08
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000844A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant