Active NPI
Reginald Fulwiley
- Home Health Aide
- West Point, MS
National Provider Identifier
1013365659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- R857836
- Practice address
- 229 West Main St
Suite 12 3Rd FL
West Point, MS 39350-0245 - Phone
- (318) 331-3619
- Fax
- (601) 510-9052
- NPI assigned
- May 24, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | R857836 | MS | Primary |
Addresses
Primary practice location
229 West Main St
Suite 12 3Rd FL
West Point, MS 39350-0245
Mailing address
PO Box 245
Philadelphia, MS 39350
Phone (318) 331-3619
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R857836 | MS | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464048000000",
"number": "1013365659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 245",
"city": "PHILADELPHIA",
"state": "MS",
"postal_code": "39350",
"telephone_number": "318-331-3619",
"fax_number": "601-510-9052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "229 WEST MAIN ST",
"address_2": "SUITE 12 3RD FL",
"city": "WEST POINT",
"state": "MS",
"postal_code": "393500245",
"telephone_number": "318-331-3619",
"fax_number": "601-510-9052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULWILEY",
"first_name": "REGINALD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-24",
"last_updated": "2016-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "MS",
"license": "R857836",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Point, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.