Amanda Ann Fulwider, MA, AT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT006116 Issued in OH

Practice address

120 Colemans Xing
Marysville, OH 43040-7115

Phone

(937) 578-7847

Fax

(937) 578-7891

NPI assigned

Sep 1, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1629445002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11596 LAFAYETTE PLAIN CITY RD",
            "city": "PLAIN CITY",
            "state": "OH",
            "postal_code": "430649010",
            "telephone_number": "937-243-9742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 COLEMANS XING",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430407115",
            "telephone_number": "937-578-7847",
            "fax_number": "937-578-7891"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Central Michigan University Rose Center - Room 145",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "MI",
            "postal_code": "488599337",
            "country_code": "US",
            "telephone_number": "937-243-9742",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 Collingwood Dr",
            "address_purpose": "LOCATION",
            "city": "Marysville",
            "state": "OH",
            "postal_code": "430409337",
            "country_code": "US",
            "telephone_number": "937-243-9742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULWIDER",
        "first_name": "AMANDA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "MA, AT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-01",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": "2000030605",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "AT006116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATHLETIC TRAINER",
            "identifier": "AT006116",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "memorialohio.com",
            "affiliation": "N",
            "address_1": "120 Colemans Xing",
            "city": "Marysville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430407115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Athletic Trainer in Marysville, OH
• Providers in Marysville, OH by specialty
• Athletic Trainer in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.