Desere Fullerton, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

694924 Issued in NY

Practice address

1024 New York Avenue
5TH Floor
Brooklyn, NY 11203

Phone

(845) 200-8228

NPI assigned

Jan 20, 2015

Sex

Female

Sole proprietor

Yes

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

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493078400000",
    "number": "1053700658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 NEW YORK AVE",
            "address_2": "1F",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112033827",
            "telephone_number": "845-200-8228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 NEW YORK AVENUE",
            "address_2": "5TH FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11203",
            "telephone_number": "845-200-8228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLERTON",
        "first_name": "DESERE",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-20",
        "last_updated": "2017-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "694924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fuller Smiles PLLC
• Frances Anne Fuller
• Karen Lackritz Fuller, MSW
• Linda Kay Fuller, NP
• Zohar Fuller
• Victoria Anne Fullerton, OTR/L
• Jessie Colter Fullmer, MD
• Fully Functional Nutrition LLC
• Fully Functional Nutrition Wellness PLLC
• Samuil Fulman, PA

• Registered Nurse in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; 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.