Nanette Nicole Fulp, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-06840 Issued in NC

Practice address

1995 Bethabara Rd
Winston Salem, NC 27106-3375

Phone

(336) 759-7596

Fax

(336) 759-3652

NPI assigned

Nov 7, 2016

Last updated

Aug 26, 2022By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: nfulp420880@direct.novanthealth.org

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

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1508308610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-759-7596",
            "fax_number": "336-759-3652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1995 BETHABARA RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063375",
            "telephone_number": "336-759-7596",
            "fax_number": "336-759-3652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULP",
        "first_name": "NANETTE",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-07",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nfulp420880@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1995 Bethabara Rd",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271063375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stanley Brian Fuller, M.D.
• Xavier Quamaine Lee Fullerton, LPC-A, CRC
• Denise V Fulller
• Fulp Therapy Services, Inc.
• Andrew G Fulp, PA-C
• Juwan Fulton
• Funderburk MD
• Whitney Bond Funderburk
• Jennifer Fuqua, PA-C
• Micaela Furest Cataldo

• Physician Assistant in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.