Katie Marie Fulk, MA, RDN, LD
Individual provider Active NPI Registered Dietitian · Churubusco, IN
NPI 1114702172 · NPPES record last updated Sep 21, 2023
Key facts
- NPI
- 1114702172
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 37002864A (IN)
- Practice address
- 12436 Bryie Rd
Churubusco, IN 46723-9225 - Phone
- (765) 744-8889
- NPI assigned
- Aug 29, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37002864A | IN | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 37002864A | IN | Yes |
Addresses
Primary practice location
12436 Bryie Rd
Churubusco, IN 46723-9225
Mailing address
PO Box 5600
Fort Wayne, IN 46895-5600
Phone (260) 266-6562
Other practice location 1
1050 Production Rd
Fort Wayne, IN 46808-4106
Phone (260) 266-6562
Other providers in Churubusco, IN
- Kimberly Lou Diller
- Don E Lahrman DDS MSD Inc
- Downing Chiropractic Center, P.C.
- Joseph Shane Downing
- Keith A. Egly
- Russell Eric Gilliom
- Susan Marie Hanke
- Dionne Justine Hladin
- Elia L Hoekstra
- Hook-Superx LLC
All providers in Churubusco, IN · Registered Dietitian in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.