Individual provider Active NPI

Joselyn Fuller, FNP-BC

  • Nurse Practitioner
  • West Jordan, UT
National Provider Identifier
1629444666
Registry record updated Apr 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
7327150 Issued in UT
Practice address
3580 W 9000 South
West Jordan, UT 84088-8899
Phone
(801) 561-8888
NPI assigned
Aug 13, 2015
Last updated
Apr 12, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 7327150-4405 UT
Nurse Practitioner 363L00000X 7327150 UT Primary

Addresses

Primary practice location

3580 W 9000 South
West Jordan, UT 84088-8899

Mailing address

PO Box 96398
Oklahoma City, OK 73143-6398
Phone (800) 962-3303

Other names 1

  • Joselyn Londer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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

Enrollment IDStateProvider typePAC IDDetails
I20151014003305 UT Practitioner - Nurse Practitioner 5991014862 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3580 W 9000
West Jordan, UT 84088-8812
Phone (801) 561-8888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
7327150UTMDNurse Practitioner
7327150-4405UTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Integrated Care, LLC CurrentSince Nov 1, 2015 Accepting new patients

Locations

1600 W Antelope Dr
Layton, UT 84041
Phone (801) 807-1000

1050 E South Temple
Slc, UT 84102
Phone (801) 350-4111

3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810

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.

NPI Registry JSON

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

{
    "created_epoch": "1439424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523491200000",
    "number": "1629444666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96398",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731436398",
            "telephone_number": "800-962-3303",
            "fax_number": "405-609-1466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 W 9000 SOUTH",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840888899",
            "telephone_number": "801-561-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JOSELYN",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-13",
        "last_updated": "2018-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "7327150-4405",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "7327150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOSELYN",
            "last_name": "LONDER",
            "credential": "FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Jordan, UT

Sources for this page

Verify at the official NPI Registry.