Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Gary Fulkerson, PA

Individual provider Medical Physician Assistant · NPI 1730165176

Gary Fulkerson, PA is a Medical Physician Assistant in Prescott Valley, Arizona. Licensed in Arizona, Nevada and Utah. Registered with an NPI since 2005.

Licensed in
AZ, NV, UT
In the registry since
2005
Specialties on file
3
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

3001 N Main St Ste 1C
Prescott Valley, AZ 86314-1215
Phone: (928) 458-5470
Fax: (928) 458-5979
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 7347 (AZ)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 103161-1206 (UT)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA1673 (NV)

Record details

NPI number1730165176
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedDecember 19, 2005
Last updated in NPPESMarch 27, 2019
Mailing address3001 N Main St Ste 1c, Prescott Valley, AZ 86314-1215

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