Mistinique J Fuller, RN, LMP

Key facts

NPI

1457736944

Entity type

Individual (NPI type 1)

Primary specialty

Nurse Massage Therapist (NMT) 163WM1400X

License

RN60154916 (WA)

Practice address

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

Phone

(509) 770-4067

NPI assigned

Jul 25, 2015

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Nurse

State licenses

Specialties & licenses

Addresses

Other names

• Mrs. Misty Fuller Other name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 5, 2021.

{
    "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"
        }
    ]
}

Other providers in Othello, WA

• Jonathan Charles Faix, LAC
• Vanessa Frank, NP
• 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

All providers in Othello, WA · Nurse Massage Therapist (NMT) in Washington