Active NPI
Nicole Renee Fullerton, MSW, CSW
- Social Worker
- Colorado Springs, CO
National Provider Identifier
1164763579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6986
- Practice address
- 25 N Spruce St
Colorado Springs, CO 80905-1436 - Phone
- (719) 227-4207
- Fax
- (719) 227-4001
- NPI assigned
- Mar 11, 2013
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 6986 | KY | Primary |
Addresses
Primary practice location
25 N Spruce St
Colorado Springs, CO 80905-1436
Mailing address
2252 Pinyon Jay Dr
Colorado Springs, CO 80951-4707
Phone (502) 741-6655
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6986 | KY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404777600000",
"number": "1164763579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2252 PINYON JAY DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809514707",
"telephone_number": "502-741-6655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 N SPRUCE ST",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809051436",
"telephone_number": "719-227-4207",
"fax_number": "719-227-4001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLERTON",
"first_name": "NICOLE",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "MSW, CSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-11",
"last_updated": "2014-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "KY",
"license": "6986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.