Katrina Lynn Fults, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

007282 Issued in IA

Practice address

5400 Kirkwood Blvd SW
Cedar Rapids, IA 52404-5216

Phone

(319) 364-0259

NPI assigned

Nov 29, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1259452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546387200000",
    "number": "1447588660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 19TH AVE",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522411616",
            "telephone_number": "319-331-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 KIRKWOOD BLVD SW",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524045216",
            "telephone_number": "319-364-0259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTS",
        "first_name": "KATRINA",
        "middle_name": "LYNN",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-29",
        "last_updated": "2019-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "007282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISW LICENSE",
            "identifier": "007282",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMSW LICENSE NUMBER",
            "identifier": "007282",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Cedar Rapids, IA
• Providers in Cedar Rapids, IA by specialty
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.