Diana Fuller,Micou

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Practice address

825 James H Meredith St
Kosciusko, MS 39090-3161

Phone

(662) 289-3699

NPI assigned

Oct 26, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1508976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508976000000",
    "number": "1205348554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 JAMES H MEREDITH ST",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 JAMES H MEREDITH ST",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903161",
            "telephone_number": "662-289-3699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER,MICOU",
        "first_name": "DIANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-26",
        "last_updated": "2017-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Imani Finley, OT
• Memorie Finnie
• Courtney Fletcher, M.S.,SLP
• Mary Fox, NURSE PRACTITIONER
• Dorothy Michele Fulgham, O.T.
• Robert Kirtis Greenlee, FNP
• Anita Greer
• Detric Griffin
• Emily Cook Gross
• Paul Devon Gundy, D.M.D.

• All providers in Kosciusko, MS
• Voluntary or Charitable Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.