Ann Marie Fulton, MSN, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN.CNP.11485 Issued in OH

Practice address

640 Glenna Dr
Fairfield, OH 45014-2719

Phone

(513) 443-1700

Fax

(513) 893-9888

NPI assigned

Aug 29, 2008

Sex

Female

Sole proprietor

No

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

Enrolled in OH

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

Specialty

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Collaborative Wellness Partners LLCGroup PAC ID 1254745334, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Collaborative Wellness Partners LLC

  dba Collaborative Wellness Partners

  • Psychiatric/Mental Health Nurse Practitioner
  • Cincinnati, OH
  • NPI 1023606647
  Medicare reassignment Care Compare group NPD
• Mindfully Psychiatry LLC

  • Psychiatry Physician
  • Montgomery, OH
  • NPI 1881341543
  Medicare reassignment NPD
• Greater Cincinnati Behavioral Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Walnut Hills, OH
  • NPI 1588626097
  NPD (past)

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

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1689822835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 GLENNA DR",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450142719",
            "telephone_number": "513-443-1700",
            "fax_number": "513-893-9888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 GLENNA DR",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450142719",
            "telephone_number": "513-443-1700",
            "fax_number": "513-893-9888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1045 W Stephenson St",
            "address_purpose": "LOCATION",
            "city": "Freeport",
            "state": "IL",
            "postal_code": "610324864",
            "country_code": "US",
            "telephone_number": "312-878-4520",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2135 Dana Ave Ste 410",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452071327",
            "country_code": "US",
            "telephone_number": "513-241-1811",
            "fax_number": "513-241-2112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULTON",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "credential": "MSN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-29",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71002668",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209017744",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.11485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0164488",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "FAIRFIELD",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "640 Glenna Dr",
            "city": "Fairfield",
            "state": "OH",
            "country_code": "US",
            "postal_code": "450142719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Peter R Fried, MD
• FSM Perio LLC (Visions Periodontics & Implantology)
• Cheryl E Fuller, STATE OF OHIO LCDCII
• Sydney Elaine Fuller
• Fulltime Transportation Services LTD
• Lydy Lwendu Fwamba
• William M Fye, D.D.S.
• G Squared
• Lisa Gaddie-Thomas
• Chantia Gaines, CNP

• Psychiatric/Mental Health Nurse Practitioner in Fairfield, OH
• Providers in Fairfield, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.