Active NPI
Susan Elaine Faulkner
- Home Health Aide
- Caruthersville, MO
National Provider Identifier
1366981102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- 4917020057897
- Practice address
- 418 Ward Ave
Caruthersville, MO 63830-1451 - Phone
- (573) 333-0030
- Fax
- (573) 333-0023
- NPI assigned
- Feb 13, 2017
- 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 |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | 4917020057897 | MO | Primary |
Addresses
Primary practice location
418 Ward Ave
Caruthersville, MO 63830-1451
Mailing address
418 Ward Ave
Caruthersville, MO 63830-1451
Phone (573) 333-0030
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548387145 | Medicaid | MO | |
| 1447303664 | Medicaid | MO |
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 |
|---|---|---|---|
| 4917020057897 | MO | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486944000000",
"number": "1366981102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "418 WARD AVE",
"city": "CARUTHERSVILLE",
"state": "MO",
"postal_code": "638301451",
"telephone_number": "573-333-0030",
"fax_number": "573-333-0023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "418 WARD AVE",
"city": "CARUTHERSVILLE",
"state": "MO",
"postal_code": "638301451",
"telephone_number": "573-333-0030",
"fax_number": "573-333-0023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAULKNER",
"first_name": "SUSAN",
"middle_name": "ELAINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-13",
"last_updated": "2017-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "MO",
"license": "4917020057897",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1548387145",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1447303664",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Caruthersville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.