Lacreasha Fullard, CRNP-PMH

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R219476 Issued in MD

Practice address

9649 Belair Rd Ste 104
Nottingham, MD 21236-1117

Phone

(410) 529-1309

Fax

(410) 529-1005

NPI assigned

Oct 9, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Mindful Haven LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Nottingham, MD
  • NPI 1093563512
  Medicare reassignment NPD
• Norkris Services, Inc

  • Community/Behavioral Health Agency
  • Havre de Grace, MD
  • NPI 1487025094

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Well Life Counseling and Consulting, LLC

  • Clinical Psychologist
  • Nottingham, MD
  • NPI 1891190054
  Medicare reassignment NPD
• Mindful Haven LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Newark, DE
  • NPI 1568325546
  NPD

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

{
    "created_epoch": "1602201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1821696196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9649 BELAIR RD STE 104",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212361117",
            "telephone_number": "410-529-1309",
            "fax_number": "410-529-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9649 BELAIR RD STE 104",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212361117",
            "telephone_number": "410-529-1309",
            "fax_number": "410-529-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLARD",
        "first_name": "LACREASHA",
        "name_prefix": "Mrs.",
        "credential": "CRNP-PMH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-09",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R219476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Free State Mental Health & Wellness LLC
• Ashiara Freeman
• Korine French
• Heather Michelle Friedman, D.D.S.
• Ilissa Frye
• Karen R Fullwood, HIS
• Natalia Fulton
• Myeisha Furr, NP
• Husham A Gabralla, DDS
• Ashley Smith Gallant, LCPC

• Psychiatric/Mental Health Nurse Practitioner in Nottingham, MD
• Providers in Nottingham, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.