Active NPI
Alissa Marie Fulton, LMP
- Specialist
- Kingston, WA
National Provider Identifier
1780948117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA 60201098
- Practice address
- 30662 Cubby Sparks PL NE
Kingston, WA 98346-9720 - Phone
- (360) 731-6764
- NPI assigned
- Jun 29, 2012
- 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 | MA 60201098 | WA | Primary |
Addresses
Primary practice location
30662 Cubby Sparks PL NE
Kingston, WA 98346-9720
Mailing address
30662 Cubby Sparks PL NE
Kingston, WA 98346-9720
Phone (360) 731-6764
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 |
|---|---|---|---|
| MA 60201098 | WA | MD | Specialist |
Interoperability endpoints
- alissa.fulton.p1@direct.pgsklallamtribe.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340928000000",
"number": "1780948117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30662 CUBBY SPARKS PL NE",
"city": "KINGSTON",
"state": "WA",
"postal_code": "983469720",
"telephone_number": "360-731-6764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30662 CUBBY SPARKS PL NE",
"city": "KINGSTON",
"state": "WA",
"postal_code": "983469720",
"telephone_number": "360-731-6764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULTON",
"first_name": "ALISSA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-29",
"last_updated": "2012-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA 60201098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingston, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.