Active NPI
Sherry Renai Fulks, EARLY INTERVENTION
- Public Health or Welfare Agency
- Mt Sterling, KY
National Provider Identifier
1700096799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health or Welfare Agency
- License
- 1667
- Practice address
- 159 Bristol LN
Mount Sterling, KY 40353-7948 - Phone
- (859) 497-0704
- Fax
- (859) 497-0704
- NPI assigned
- May 22, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | 1667 | KY | Primary |
Addresses
Primary practice location
159 Bristol LN
Mount Sterling, KY 40353-7948
Mailing address
159 Bristol LN
Mount Sterling, KY 40353-7948
Phone (859) 497-0704
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1667 | Other | KY | GATEWAY FIRST STEPS PROV. |
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 |
|---|---|---|---|
| 1667 | KY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700096799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "159 BRISTOL LN",
"city": "MOUNT STERLING",
"state": "KY",
"postal_code": "403537948",
"telephone_number": "859-497-0704",
"fax_number": "859-497-0704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 BRISTOL LN",
"city": "MOUNT STERLING",
"state": "KY",
"postal_code": "403537948",
"telephone_number": "859-497-0704",
"fax_number": "859-497-0704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULKS",
"first_name": "SHERRY",
"middle_name": "RENAI",
"name_prefix": "Mrs.",
"credential": "EARLY INTERVENTION",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "251K00000X",
"taxonomy_group": "",
"desc": "Public Health or Welfare",
"state": "KY",
"license": "1667",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY FIRST STEPS PROV.",
"identifier": "1667",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mt Sterling, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.