Fatia A Russell

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

108796 Issued in NC

Practice address

6245 Lakehaven Dr
Fayetteville, NC 28304-0610

Phone

(910) 479-6214

NPI assigned

Mar 6, 2018

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Pure Gold Luxz Hair Beauty Luxury

  • Prosthetist
  • Fayetteville, NC
  • NPI 1306400759

  Multi-Specialty

  NPD Authorized official

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

{
    "created_epoch": "1520294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567209600000",
    "number": "1356843379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6245 LAKEHAVEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283040610",
            "telephone_number": "910-479-6214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6245 LAKEHAVEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283040610",
            "telephone_number": "910-479-6214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "FATIA",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-06",
        "last_updated": "2019-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Prosthetist",
            "state": "NC",
            "license": "108796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108796",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tabitha Lynn Russ, MSW, LCSWA
• Jasmyne Russell-Dicker, CPPS
• Ashley Russell-Gray, PA-C
• Laurie Rae Russell-Peabody, LCSWA, MSW, BSW
• Cynthia Reed Russell, NNP
• Kim Marie Russell, RRT
• Kristin Erryn Russell, PA-C
• Valerie Russell, LCSW-A
• Danielle S Rutherford, DO
• Katie Michelle Rutherford

• Prosthetist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Prosthetist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2019; 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.