Fallon Funderburk, BSN, RN, CNOR, RNFA

Primary specialty

Registered Nurse First AssistantTaxonomy code 163WR0006X

License

RN105855 Issued in LA

Practice address

1101 Kaliste Saloom Rd
Lafayette, LA 70508-5705

Phone

(337) 769-4241

Fax

(337) 769-4249

NPI assigned

Nov 22, 2014

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

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.

• Surgical Assistants of Acadiana, LLC

  • Registered Nurse First Assistant
  • Lafayette, LA
  • NPI 1770007684
  NPD (past) Authorized official

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

{
    "created_epoch": "1416614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501545600000",
    "number": "1386041150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 RUE DE FREJUS",
            "city": "BROUSSARD",
            "state": "LA",
            "postal_code": "705184993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 KALISTE SALOOM RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085705",
            "telephone_number": "337-769-4241",
            "fax_number": "337-769-4249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDERBURK",
        "first_name": "FALLON",
        "name_prefix": "Mrs.",
        "credential": "BSN, RN, CNOR, RNFA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-22",
        "last_updated": "2017-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "LA",
            "license": "RN105855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Gary Fulgence
• Full Spectrum ABA of Louisiana
• George H Fuller, M.D.
• Heather Fuller, MSW, LCSW
• Leighanna R Fulton, MS, LPC
• Natalie Wright Funderburk, CRNA
• Hazel M Fuselier, SOCIAL WORKER
• John Fuselier, MD
• Jude K Fuselier, PHARMD
• Shawdyah Fuselier, LPC

• Registered Nurse First Assistant in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Registered Nurse First Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.

Verify at the official NPI Registry.