Lydia Suzanne Fulton, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA09733 Issued in TX

Practice address

508 Highmoor CT
Oak Point, TX 75068-6136

Phone

(618) 335-0992

NPI assigned

Sep 18, 2009

Last updated

Apr 17, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bear Lake Professionals Inc

  dba Big Bear Urgent Care

  • Urgent Care Clinic/Center
  • Johns Island, SC
  • NPI 1831386705
  NPD

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

{
    "created_epoch": "1253232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429228800000",
    "number": "1407180763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 HIGHMOOR CT",
            "city": "OAK POINT",
            "state": "TX",
            "postal_code": "750686136",
            "telephone_number": "618-335-0992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 HIGHMOOR CT",
            "city": "OAK POINT",
            "state": "TX",
            "postal_code": "750686136",
            "telephone_number": "618-335-0992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTON",
        "first_name": "LYDIA",
        "middle_name": "SUZANNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-18",
        "last_updated": "2015-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "22766",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaricia Gwendolyn Daniels
• Evercare Medical Transportation LLC
• Derek A Farley, DO
• Patricia Ann Flores, RN
• Amanda Rae Foltz, MA, MS, NCC, LPC-A
• Andrew Garza
• David Crockett Harper, MD
• Lima Concepts
• Lizah Mandiringa
• Heidi McKay

• Physician Assistant in Oak Point, TX
• Providers in Oak Point, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; 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.