Mistinique J Fuller, RN, LMP

Primary specialty

Nurse Massage Therapist (NMT)Taxonomy code 163WM1400X

License

RN60154916 Issued in WA

Practice address

1100 E Main St Ste a
Othello, WA 99344-1587

Phone

(509) 770-4067

NPI assigned

Jul 25, 2015

Last updated

Oct 5, 2021By the provider in NPPES

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 names 1

• Mrs. Misty Fuller Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1437782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1457736944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1968 W MUSE RD",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993449757",
            "telephone_number": "509-770-4067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E MAIN ST STE A",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441587",
            "telephone_number": "509-770-4067"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1968 W Muse Rd",
            "address_purpose": "LOCATION",
            "city": "Othello",
            "state": "WA",
            "postal_code": "993449757",
            "country_code": "US",
            "telephone_number": "509-770-4067",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MISTINIQUE",
        "middle_name": "J",
        "credential": "RN, LMP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-25",
        "last_updated": "2021-10-05",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM1400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Nurse Massage Therapist (NMT)",
            "state": "WA",
            "license": "RN60154916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MISTY",
            "last_name": "FULLER",
            "prefix": "MRS.",
            "credential": "RN, LMP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Samantha Jo Eslinger
• Jonathan Charles Faix, LAC
• Noah Robert Frerichs, D.M.D.
• Harvey Richard Fritz, DO
• Ian Fuger, DMD
• Laurie Gadbois, RDH
• Leo Gaeta
• Aylin Garcia, SC
• Elsie Aileen Garza, MSW
• Veniel Garza, DO

• Nurse Massage Therapist (NMT) in Othello, WA
• Providers in Othello, WA by specialty
• Nurse Massage Therapist (NMT) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.