Sara Fulkerson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW23886 Issued in FL

Practice address

395 Palm Coast Pkwy SW Unit 4
Palm Coast, FL 32137-4768

Phone

(904) 512-0018

NPI assigned

Jan 21, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Cleetherapy

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Palm Coast, FL
  • NPI 1700445350
  NPD

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1447840657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 PALM COAST PKWY SW UNIT 4",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321374768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 PALM COAST PKWY SW UNIT 4",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321374768",
            "telephone_number": "904-512-0018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULKERSON",
        "first_name": "SARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-21",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "ISW17999",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW23886",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Stanley Frederick, M.D.
• Eric William Freiler, DPM
• Ryan Frezza
• Florence Robert Fruehan, DO
• Kristen Ann Fuentes, HAS
• Richard Sean Fulmer, LMT, CPT
• Aislynn Christine Fulton, M.A.
• Functional Integrative Training, Inc.
• Nick Furlong
• Michael Gable, DO

• Clinical Social Worker in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; 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.