Active NPI
Lynsie Fulkerson, PHARMD
- Pharmacist
- Lake Charles, LA
National Provider Identifier
1063018018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PST.023626
- Practice address
- 1701 Oak Park Blvd
Lake Charles, LA 70601-8911 - Phone
- (337) 494-3180
- NPI assigned
- Dec 7, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | PST.023626 | LA | Primary |
Addresses
Primary practice location
1701 Oak Park Blvd
Lake Charles, LA 70601-8911
Mailing address
1015 Arthur Bourgeois Rd
Kaplan, LA 70548-5274
Phone (337) 652-1596
Other practice location 1
2500 N Martin Luther King Hwy
Lake Charles, LA 70601-1307
Phone (337) 436-3909
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PST.023626 | Other | LA | LOUISIANA BOARD OF PHARMACY |
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PST.023626 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607299200000",
"number": "1063018018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1015 ARTHUR BOURGEOIS RD",
"city": "KAPLAN",
"state": "LA",
"postal_code": "705485274",
"telephone_number": "337-652-1596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 OAK PARK BLVD",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706018911",
"telephone_number": "337-494-3180"
}
],
"practiceLocations": [
{
"address_1": "2500 N Martin Luther King Hwy",
"address_purpose": "LOCATION",
"city": "Lake Charles",
"state": "LA",
"postal_code": "706011307",
"country_code": "US",
"telephone_number": "337-436-3909",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FULKERSON",
"first_name": "LYNSIE",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-07",
"last_updated": "2020-12-07",
"certification_date": "2020-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "PST.023626",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LOUISIANA BOARD OF PHARMACY",
"identifier": "PST.023626",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.