Active NPI
Donald V Fuller, PHD, ATC, LAT
- Athletic Trainer
- Barbourville, KY
National Provider Identifier
1649872201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT1608
- Practice address
- 310 College St
Barbourville, KY 40906-1499 - Phone
- (606) 546-1509
- NPI assigned
- Nov 9, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT1608 | KY | Primary |
Addresses
Primary practice location
310 College St
Barbourville, KY 40906-1499
Mailing address
310 College St
Barbourville, KY 40906-1499
Phone (678) 221-7963
Other names 1
- Donald V Fuller
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT1608 | KY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604880000000",
"number": "1649872201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 COLLEGE ST",
"city": "BARBOURVILLE",
"state": "KY",
"postal_code": "409061499",
"telephone_number": "678-221-7963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 COLLEGE ST",
"city": "BARBOURVILLE",
"state": "KY",
"postal_code": "409061499",
"telephone_number": "606-546-1509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "DONALD",
"middle_name": "V",
"credential": "PHD, ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-09",
"last_updated": "2020-11-09",
"certification_date": "2020-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "KY",
"license": "AT1608",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DONALD",
"last_name": "FULLER",
"middle_name": "V",
"credential": "PHD, ATC, LAT",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Barbourville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.