Active NPI
Carolyn Starr Fullmer, PAC
- Physician Assistant
- Chewelah, WA
National Provider Identifier
1275686669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10003285
- Practice address
- 410 E King St
Chewelah, WA 99109-0137 - Phone
- (509) 935-8711
- Fax
- (509) 935-4882
- NPI assigned
- Jan 19, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10003285 | WA | Primary |
Addresses
Primary practice location
410 E King St
Chewelah, WA 99109-0137
Mailing address
PO Box 137
Chewelah, WA 99109-0137
Phone (509) 935-8711
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8511230 | Medicaid | WA | |
| 0159376 | Other | WA | WA STATE L&I |
| PA10003285 | Other | WA | WA STATE LICENSE |
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)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Colville Nation Community Health Centers | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Inchelium, WA
- NPI 1679697155
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213747200000",
"number": "1275686669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 137",
"city": "CHEWELAH",
"state": "WA",
"postal_code": "991090137",
"telephone_number": "509-935-8711",
"fax_number": "509-935-4882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 E KING ST",
"city": "CHEWELAH",
"state": "WA",
"postal_code": "991090137",
"telephone_number": "509-935-8711",
"fax_number": "509-935-4882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLMER",
"first_name": "CAROLYN",
"middle_name": "STARR",
"name_prefix": "Ms.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-19",
"last_updated": "2008-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10003285",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8511230",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA STATE L&I",
"identifier": "0159376",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA STATE LICENSE",
"identifier": "PA10003285",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chewelah, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.