Active NPI
Justin Fuller, CRNP
- Family Nurse Practitioner
- Pell City, AL
National Provider Identifier
1013565613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 1-131835
- Practice address
- 70 Plaza Dr
Pell City, AL 35125-9314 - Phone
- (205) 814-9284
- Fax
- (205) 814-9626
- NPI assigned
- Aug 28, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1-131835 | AL | Primary |
Addresses
Primary practice location
70 Plaza Dr
Pell City, AL 35125-9314
Mailing address
70 Plaza Dr
Pell City, AL 35125-9314
Phone (205) 814-9284
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)
- Enrolled
- Credentials
- Certified Registered Nurse
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566950400000",
"number": "1013565613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "70 PLAZA DR",
"city": "PELL CITY",
"state": "AL",
"postal_code": "351259314",
"telephone_number": "205-814-9284",
"fax_number": "205-814-9626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "70 PLAZA DR",
"city": "PELL CITY",
"state": "AL",
"postal_code": "351259314",
"telephone_number": "205-814-9284",
"fax_number": "205-814-9626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "JUSTIN",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-28",
"last_updated": "2019-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AL",
"license": "1-131835",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pell City, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.