Active NPI
Jill Kathleen Fulk, RD, LD, CDE
- Registered Dietitian
- Mansfield, OH
National Provider Identifier
1558482299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 5038
- Practice address
- 335 Glessner Ave
Mansfield, OH 44903-2269 - Phone
- (419) 526-8471
- Fax
- (419) 526-8939
- NPI assigned
- Apr 2, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 5038 | OH | Primary |
Addresses
Primary practice location
335 Glessner Ave
Mansfield, OH 44903-2269
Mailing address
1394 State Route 603
Ashland, OH 44805-9723
Phone (419) 207-0212
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 |
|---|---|---|---|
| 5038 | OH | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medcentral Professional Foundation, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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- Mansfield, OH
- NPI 1841476942
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558482299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1394 STATE ROUTE 603",
"city": "ASHLAND",
"state": "OH",
"postal_code": "448059723",
"telephone_number": "419-207-0212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 GLESSNER AVE",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449032269",
"telephone_number": "419-526-8471",
"fax_number": "419-526-8939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULK",
"first_name": "JILL",
"middle_name": "KATHLEEN",
"name_prefix": "Mrs.",
"credential": "RD, LD, CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": "5038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.