Provider Demographics
NPI:1023441870
Name:FULTS-MCMURTERY, REGINA SHARNEE (PHD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:SHARNEE
Last Name:FULTS-MCMURTERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 PEARLIE OWENS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3276
Mailing Address - Country:US
Mailing Address - Phone:601-562-9763
Mailing Address - Fax:
Practice Address - Street 1:661 HIGHWAY 51
Practice Address - Street 2:SUITE 1D
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2130
Practice Address - Country:US
Practice Address - Phone:601-562-9763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional