Active NPI
Virginia Brooke Faulkner, DMD
- Dentist
- Covington, KY
National Provider Identifier
1003264888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9747
- Practice address
- 1401 Madison Ave
Covington, KY 41011-3313 - Phone
- (859) 655-6100
- Fax
- (859) 655-6179
- NPI assigned
- Jun 2, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30.24774 | OH | |
| Dentist | 122300000X | 9747 | KY | Primary |
Addresses
Primary practice location
1401 Madison Ave
Covington, KY 41011-3313
Mailing address
215 E 11TH St
Newport, KY 41071-2203
Phone (859) 655-6100
Other practice location 1
9415 Fields Ertel Rd
Cincinnati, OH 45249-8212
Phone (513) 482-1828
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100410240 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170330000552 | KY | Order and Referring Only - Dentist | 1658656897 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30.24774 | OH | MD | Dentist |
Networks
- devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
- TN PPO C-SNP
- KY PPO C-SNP
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615766400000",
"number": "1003264888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 E 11TH ST",
"city": "NEWPORT",
"state": "KY",
"postal_code": "410712203",
"telephone_number": "859-655-6100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 MADISON AVE",
"city": "COVINGTON",
"state": "KY",
"postal_code": "410113313",
"telephone_number": "859-655-6100",
"fax_number": "859-655-6179"
}
],
"practiceLocations": [
{
"address_1": "9415 Fields Ertel Rd",
"address_purpose": "LOCATION",
"city": "Cincinnati",
"state": "OH",
"postal_code": "452498212",
"country_code": "US",
"telephone_number": "513-482-1828",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FAULKNER",
"first_name": "VIRGINIA",
"middle_name": "BROOKE",
"name_prefix": "Ms.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-02",
"last_updated": "2021-03-15",
"certification_date": "2021-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30.24774",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "9747",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100410240",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Covington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.