Michael Hugh Fulkerson, MAE, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

104746 Issued in KY

Practice address

1100 Walnut St
Owensboro, KY 42301-2956

Phone

(270) 689-6681

Fax

(270) 689-6677

NPI assigned

Jun 25, 2014

Last updated

Jun 6, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Rivervalley Behavioral Health Inc

  dba RiverValley Behavioral Health

  • Community Health Clinic/Center
  • Owensboro, KY
  • NPI 1285689711
  Medicare reassignment NPD

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

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465171200000",
    "number": "1033524236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3731 FREDERICA ST",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423016975",
            "telephone_number": "270-689-6681",
            "fax_number": "270-689-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WALNUT ST",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423012956",
            "telephone_number": "270-689-6681",
            "fax_number": "270-689-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULKERSON",
        "first_name": "MICHAEL",
        "middle_name": "HUGH",
        "name_prefix": "Mr.",
        "credential": "MAE, LPCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-25",
        "last_updated": "2016-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "KY - 0223",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "104746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100337270",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Andrew Frey, PHARM. D.
• Vicki L Frey, D.M.D.
• Laura M Fritz, LCSW
• Kelley Fulkerson, LCSW
• Megan Marie Fulkerson, APRN
• Shana Fulkerson, CSW
• Allie Shea Fuller
• Haley Marie Fuller, APRN
• Heather Fuller, PHARMD, MBA
• Johnathan T Fuller, PHARM.D.

• Professional Counselor in Owensboro, KY
• Providers in Owensboro, KY by specialty
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; 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.

Verify at the official NPI Registry.