Active NPI
William Fullerton
- Clinical Social Worker
- Saint Paul, MN
National Provider Identifier
1326216243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 17097
- Practice address
- 451 Lexington Pkwy N
Saint Paul, MN 55104-4636 - Phone
- (651) 280-2309
- NPI assigned
- Feb 13, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 17097 | MN | Primary |
Addresses
Primary practice location
451 Lexington Pkwy N
Saint Paul, MN 55104-4636
Mailing address
451 Lexington Pkwy N
Saint Paul, MN 55104-4636
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 |
|---|---|---|---|
| 17097 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202860800000",
"number": "1326216243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "451 LEXINGTON PKWY N",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 LEXINGTON PKWY N",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044636",
"telephone_number": "651-280-2309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLERTON",
"first_name": "WILLIAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-13",
"last_updated": "2008-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "17097",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.