Joshua Campbell Fulwiler, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

581025 Issued in MS

Practice address

2625 Traceland Dr Ste B
Tupelo, MS 38801-4240

Phone

(662) 269-3599

Fax

(662) 259-2503

NPI assigned

Jul 13, 2015

Last updated

Sep 23, 2019By the provider in NPPES

Sex

Male

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 MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cardinal Clinical Consulting, LLC

  • Clinical Psychologist
  • Tupelo, MS
  • NPI 1417514274
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1841674645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 HIGHWAY 7 S",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555392",
            "telephone_number": "662-234-7521",
            "fax_number": "662-236-3071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 TRACELAND DR STE B",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014240",
            "telephone_number": "662-269-3599",
            "fax_number": "662-259-2503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULWILER",
        "first_name": "JOSHUA",
        "middle_name": "CAMPBELL",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-13",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MS",
            "license": "581025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Friloux, MD
• Mary Frost
• Jordan Danielle Fugett
• Leslie Fugett, LMSW
• Relda Fugitt
• Functional Therapy Center, Inc.
• Chacie Marie Funderburk, BSN, RN
• Mary Gadus, FNP
• Shelley A Gaggini, DIETITIAN
• Kendal Gaines

• Clinical Psychologist in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Clinical Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; 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.