Active NPI
Tera Marie Fawkes
- Driver
- Grand Junction, CO
National Provider Identifier
1538875505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- B4404799
- Practice address
- 488 Bing St
Grand Junction, CO 81504-6113 - Phone
- (970) 589-0027
- NPI assigned
- Jan 24, 2023
- Last updated
- Jan 24, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | B4404799 | CA | Primary |
Addresses
Primary practice location
488 Bing St
Grand Junction, CO 81504-6113
Mailing address
488 Bing St
Grand Junction, CO 81504-6113
Phone (970) 589-0027
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P586842 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B4404799 | CA | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674518400000",
"number": "1538875505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "488 BING ST",
"city": "GRAND JUNCTION",
"state": "CO",
"postal_code": "815046113",
"telephone_number": "970-589-0027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "488 BING ST",
"city": "GRAND JUNCTION",
"state": "CO",
"postal_code": "815046113",
"telephone_number": "970-589-0027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAWKES",
"first_name": "TERA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-24",
"last_updated": "2023-01-24",
"certification_date": "2023-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "CA",
"license": "B4404799",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "P586842",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Junction, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.