Provider Demographics
NPI:1598479495
Name:FULK, CAITLYN
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:FULK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 FRIENDSVILLE RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7131
Mailing Address - Country:US
Mailing Address - Phone:330-202-3420
Mailing Address - Fax:330-202-3347
Practice Address - Street 1:3727 FRIENDSVILLE RD UNIT 5
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7131
Practice Address - Country:US
Practice Address - Phone:302-023-4203
Practice Address - Fax:330-202-3347
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008799RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant