Michael Fuller, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LPN0000092565 Issued in TN

Practice address

1539 Cuba Rd
Mayfield, KY 42066-6809

Phone

(270) 251-2924

NPI assigned

Jun 17, 2019

Last updated

Jun 17, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tncoviddefense

  • Nursing Care Agency
  • McKenzie, TN
  • NPI 1801560768
  NPD Authorized official
• Western Ky Regional MHMR Board Inc

  dba Four Rivers Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Paducah, KY
  • NPI 1841216934
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1013577667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 BROADWAY ST STE 201",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420010713",
            "telephone_number": "270-442-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 CUBA RD",
            "city": "MAYFIELD",
            "state": "KY",
            "postal_code": "420666809",
            "telephone_number": "270-251-2924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MICHAEL",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TN",
            "license": "LPN0000092565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Will Foston, MD
• Four River Behavioral Health
• Freeman Dental
• Freeman Dental PLLC
• Bryan Douglas Freeman, D.M.D.
• Fulton Home Care Services LLC (Regional Home Care, Purchase Parkway)
• Addison Futrell
• Jocelyn Gallagher, CADC
• Barbara Jean Gann, LMT
• Kayla Michelle Garrott, APRN

• Licensed Practical Nurse in Mayfield, KY
• Providers in Mayfield, KY by specialty
• Licensed Practical Nurse in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.

Verify at the official NPI Registry.