Individual provider Active NPI

Danielle Fulkrod, PHARM D

  • Pharmacist
  • Mountain City, TN
National Provider Identifier
1184007882
Registry record updated Apr 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
39961 Issued in TN
Practice address
103 N Shady St
Mountain City, TN 37683-1333
Phone
(423) 727-5651
NPI assigned
Jun 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 0202214028 VA
Pharmacist 183500000X 39961 TN Primary
Pharmacist 183500000X RP0009444 WV

Addresses

Primary practice location

103 N Shady St
Mountain City, TN 37683-1333

Mailing address

103 N Shady St
Mountain City, TN 37683-1333
Phone (423) 727-5651

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

LicenseStateTypeSpecialty
39961TNMDPharmacist
0202214028VAMDPharmacist
RP0009444WVMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492128000000",
    "number": "1184007882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 N SHADY ST",
            "city": "MOUNTAIN CITY",
            "state": "TN",
            "postal_code": "376831333",
            "telephone_number": "423-727-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N SHADY ST",
            "city": "MOUNTAIN CITY",
            "state": "TN",
            "postal_code": "376831333",
            "telephone_number": "423-727-5651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULKROD",
        "first_name": "DANIELLE",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-30",
        "last_updated": "2017-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202214028",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "39961",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WV",
            "license": "RP0009444",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.