Karen J Fulwood, NP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Myrtle Beach, SC
NPI 1164414520 · NPPES record last updated Jul 31, 2025
Key facts
- NPI
- 1164414520
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 3301 (SC)
- Practice address
- 401 79TH Ave N
Myrtle Beach, SC 29572-4310 - Phone
- (843) 948-1191
- Fax
- (843) 948-1192
- NPI assigned
- Aug 22, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 20
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Mofdaps and Company
Rebound Behavioral Health LLC
Lifesource of North Carolina
Practice addresses (Care Compare)
110 Cherry St
Darlington, SC 29532-3904
Phone (843) 968-8120
1203 48TH Ave N
Suite 202
Myrtle Beach, SC 29577-5425
Phone (843) 449-2576
134 E Rebound Rd
Lancaster, SC 29720-7712
Phone (803) 313-3700
939 Springdale Dr
Clinton, SC 29325-7266
Phone (910) 742-9243
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA, SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090409000621 | IA | Practitioner - Nurse Practitioner | 6608923578 | Reassigns benefits to 1 organization |
| I20141124000655 | SC | Practitioner - Nurse Practitioner | 6608923578 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201429 | NC | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mofdaps and Company | Current |
Accepting new patients | |
| Mercy Specialty Clinic | Current |
Accepting new patients | |
| Mental Health Specialty Group PA | Current |
Accepting new patients | |
| Lifesource of North Carolina | Psychiatric/Mental Health | Current |
Accepting new patients |
| Lifesource of North Carolina | Current |
Accepting new patients | |
| Medical Associates of Clinton, Iowa P.L.C. | Current | Accepting new patients | |
| Lifesource Prime Inc | Current |
Accepting new patients | |
| Lifesource Prime Inc | Primary Care | Current |
Accepting new patients |
| Mercy Specialty Clinic | Current |
Accepting new patients | |
| A Nu Care Wellness Center Inc | Psychiatric/Mental Health | Current |
Accepting new patients |
| Ronald Cassidy LPC | Past |
Accepting new patients |
Locations
915 13th Ave N
Clinton, IA 52732
Phone (319) 243-2511
170 Meeting St
Charleston, SC 29401
Phone (843) 983-8320
110 Cherry St
Darlington, SC 29532
Phone (843) 393-5831
1203 48th Ave N
Ste 202
Myrtle Beach, SC 29577
Phone (843) 449-2576
1915 Ebenezer Rd
Rock Hill, SC 29732
Phone (305) 866-9951
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 201429 | NC | |
| Primary Care Nurse Practitioner | 363LP2300X | 201429 | NC | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 3301 | SC | Yes |
Addresses
Primary practice location
401 79TH Ave N
Myrtle Beach, SC 29572-4310
Mailing address
103 Nez Perce Dr
Darlington, SC 29532-4237
Phone (563) 495-8861
Other practice location 1
103 Nez Perce Dr
Darlington, SC 29532-4237
Phone (563) 495-8861
Other practice location 2
200 Mercy Dr
Suite 200
Dubuque, IA 52001-7303
Phone (563) 582-0145
Other practice location 3
MOFDAPS Comprehensive Behavioral Health Services
1203 48th Avenue North
Myrtle Beach, SC 29577
Phone (843) 449-2576
Other practice location 4
708 Pearl St
Darlington, SC 29532-3842
Phone (843) 535-6803
Other practice location 5
201 Cashua St
Darlington, SC 29532-3301
Phone (843) 395-8422
Other practice location 6
1800 2nd Loop Rd Ste 1
Florence, SC 29501-6180
Phone (843) 968-3395
Other practice location 7
110 Cherry St
Darlington, SC 29532-3904
Phone (843) 968-3395
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6005035 | Medicaid | NC | |
| 2632023 | Other | UNITED HEALTHCARE | |
| NP2798 | Medicaid | SC |
Other providers in Myrtle Beach, SC
- Thomas D. Fritz
- Front Door Physicians
- Willa Fry
- FS Tenant Pool I Trust
- FSQ Pharmacy Holdings, LLC
- William A Funderburk Jr.
- Cynthia Marie Funston
- Juliemar Bonilla Furr
- Elizabeth Whittier Fusaro
- Fyrebird Recovery
All providers in Myrtle Beach, SC · Psychiatric/Mental Health Nurse Practitioner in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.