Active NPI
Tamika Raynelle Fulton
- Surgical Technologist
- Las Vegas, NV
National Provider Identifier
1407649353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 7634002
- Practice address
- 3275 S Jones Blvd Ste 106
Las Vegas, NV 89146-6768 - Phone
- (725) 237-1300
- NPI assigned
- May 23, 2025
- 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 |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | 7634002 | KS | Primary |
Addresses
Primary practice location
3275 S Jones Blvd Ste 106
Las Vegas, NV 89146-6768
Mailing address
1950 N Walnut Rd Apt 114
Las Vegas, NV 89115-6422
Phone (702) 884-4678
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 |
|---|---|---|---|
| 7634002 | KS | MD | Surgical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747958400000",
"number": "1407649353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 N WALNUT RD APT 114",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891156422",
"telephone_number": "702-884-4678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3275 S JONES BLVD STE 106",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891466768",
"telephone_number": "725-237-1300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULTON",
"first_name": "TAMIKA",
"middle_name": "RAYNELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-23",
"last_updated": "2025-05-23",
"certification_date": "2025-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "KS",
"license": "7634002",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.