Nicole Middleton Fuller, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP04408 Issued in LA

Practice address

2516 Broadmoor Blvd
Monroe, LA 71201-2988

Phone

(318) 322-1161

Fax

(318) 322-9313

NPI assigned

Mar 1, 2007

Last updated

Dec 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Nicole Fuller Professional name

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Francis Medical Group LLCGroup PAC ID 5092970624, 176 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fmol Health St Francis Hospital, Monroe, LA, CCN 190125

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• St Francis Medical Group LLC

  • Internal Medicine Physician
  • Monroe, LA
  • NPI 1134405087
  Medicare reassignment Care Compare group NPD
• Affinity Health Group, LLC

  • Family Medicine Physician
  • Monroe, LA
  • NPI 1023291226
  Medicare reassignment NPD
• Affinity Health Group, LLC

  dba Affinity Health Management Center

  • Speech-Language Pathologist
  • Monroe, LA
  • NPI 1053722066
  NPD
• Affinity Health Group, LLC

  dba Affinity Orthopaedic Clinic

  • Orthopaedic Surgery Physician
  • Monroe, LA
  • NPI 1861879249
  NPD
• Internal Medicine of the Twin Cities

  • Internal Medicine Physician
  • Monroe, LA
  • NPI 1912956863
  NPD (past)
• St Francis Medical Center, Inc

  • Rehabilitation Hospital Unit
  • Monroe, LA
  • NPI 1013906239
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Francis Medical Center, Inc

  • General Acute Care Hospital
  • Monroe, LA
  • NPI 1295723229
  Care Compare affiliation

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1083742993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DESIARD ST STE 355",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017363",
            "telephone_number": "318-807-7875",
            "fax_number": "318-812-6603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 BROADMOOR BLVD",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712012988",
            "telephone_number": "318-322-1161",
            "fax_number": "318-322-9313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "312 Grammont St Ste 404",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "712017403",
            "country_code": "US",
            "telephone_number": "318-966-6800",
            "fax_number": "318-966-6801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "NICOLE",
        "middle_name": "MIDDLETON",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP04408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00625589",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1473286",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "FULLER",
            "credential": "FNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Shaina Frost, LPC
• Tiffany P. Frost
• Carl Evan Frusha, LPC
• Laurie Marie Fulford, LCSW
• Jeffery Fuller, M.D.
• Tiffany Fuller
• Jasmine Nicole Fusilier
• Pamela Futch, LCSW
• G B Cooley Hospital for Retarded (G B Cooley Hospital Services)
• G B Cooley Hospital for Retarded (GBC Behavioral Health Hospital)

• Family Nurse Practitioner in Monroe, LA
• Providers in Monroe, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.