Jacob Dean Fuller, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

201230678LPN Issued in OR

Practice address

3333 Riverbend Dr
Springfield, OR 97477-8800

Phone

(877) 350-7430

NPI assigned

May 7, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367884800000",
    "number": "1720423536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 36TH ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974785789",
            "telephone_number": "541-513-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 RIVERBEND DR",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974778800",
            "telephone_number": "877-350-7430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JACOB",
        "middle_name": "DEAN",
        "name_prefix": "Mr.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-07",
        "last_updated": "2013-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OR",
            "license": "201230678LPN",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WV",
            "license": "28704",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lexie Kay Frint, PHARMD
• Cathleen Fritz
• Kay Ann Froemming, RN CPNP IBLC
• Thomas Gaston Frye IV, CADC II
• April Fuller, ANP
• Cynthia Kay Fulton-Tinawi, RN
• Denna Marie Fulton, LCSW, QMHP, CADCIII
• G Street Integrated Health
• G Street Integrated Health
• G Street Integrated Health

• Licensed Practical Nurse in Springfield, OR
• Providers in Springfield, OR by specialty
• Licensed Practical Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; 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.