Active NPI
Jodie L Fullerton
- Specialist
- Yakima, WA
National Provider Identifier
1679704613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA00016698
- Practice address
- 208 N 3Rd Ave
Yakima, WA 98902-2632 - Phone
- (509) 965-5750
- Fax
- (509) 965-8257
- NPI assigned
- Aug 6, 2009
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | MA00016698 | WA | Primary |
Addresses
Primary practice location
208 N 3Rd Ave
Yakima, WA 98902-2632
Mailing address
208 N 3Rd Ave
Yakima, WA 98902-2632
Phone (509) 965-5750
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 |
|---|---|---|---|
| MA00016698 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249516800000",
"number": "1679704613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 N 3RD AVE",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989022632",
"telephone_number": "509-965-5750",
"fax_number": "509-965-8257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 N 3RD AVE",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989022632",
"telephone_number": "509-965-5750",
"fax_number": "509-965-8257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLERTON",
"first_name": "JODIE",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-06",
"last_updated": "2009-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA00016698",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yakima, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.