Dixie Lynn Fulk, PHYSICIAN ASSISTANT
Individual provider Active NPI Physician Assistant · King, NC
NPI 1275367237 · NPPES record last updated Nov 13, 2024
Key facts
- NPI
- 1275367237
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 001014530 (NC)
- Practice address
- 216 Moore Rd
King, NC 27021-8703 - Phone
- (336) 983-4346
- Fax
- (336) 985-5101
- NPI assigned
- Aug 30, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 21
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Novant Health Medical Group, LLC
Forsyth Memorial Hospital Inc
Practice addresses (Care Compare)
167 Moore Rd
King, NC 27021-8770
216 Moore Rd
King, NC 27021-8703
Phone (336) 983-4346
2825 Lyndhurst Ave
Winston Salem, NC 27103-4146
291 Broad St
Kernersville, NC 27284-2932
Phone (336) 993-8181
3641 Westgate Ctr Cir
Suite a
Winston Salem, NC 27103-4146
Phone (704) 384-8200
6301 Stadium Dr
Clemmons, NC 27012-8766
Phone (336) 766-6473
Hospital & facility affiliations
- Centerwell Home Health
- Novant Health Forsyth Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241030003790 | NC | Practitioner - Physician Assistant | 2860925740 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001014530 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forsyth Memorial Hospital, Inc. | Current |
Accepting new patients | |
| Novant Medical Group Inc | Current |
Accepting new patients | |
| Forsyth Memorial Hospital, Inc. | Current |
Accepting new patients | |
| Novant Health Medical Group, LLC | Current |
Accepting new patients | |
| Forsyth Memorial Hospital, Inc | Past | Accepting new patients |
Locations
10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000
6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473
291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181
216 Moore Rd
King, NC 27021
Phone (336) 768-1270
865 Westlake Dr
Mount Airy, NC 27030
Phone (336) 719-6100
5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441
100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560
2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300
Interoperability endpoints
- dfulk1615292@direct.novanthealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001014530 | NC | Yes |
Addresses
Primary practice location
216 Moore Rd
King, NC 27021-8703
Mailing address
PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 983-4346
Other providers in King, NC
- William R Fox
- Jamie Frazier
- Stephanie Amber Freeman
- Elizabeth Frye
- Corey Fulk
- Jennifer Mickey Fulp
- Gary V. Monteith DDS PA
- Gastroenterology Associates of the Piedmont, P.a.
- Matthew J. Germini
- Rebecca J Gibson
All providers in King, NC · Physician Assistant in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.