Coy Fullen, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

O-0589 Issued in ID

Practice address

427 N 12TH St
Plummer, ID 83851

Phone

(208) 686-1931

Fax

(208) 686-5133

NPI assigned

Dec 12, 2006

Last updated

May 16, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526428800000",
    "number": "1902967243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 388",
            "city": "PLUMMER",
            "state": "ID",
            "postal_code": "838510388",
            "telephone_number": "208-686-1931",
            "fax_number": "208-686-5133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 N 12TH ST",
            "city": "PLUMMER",
            "state": "ID",
            "postal_code": "83851",
            "telephone_number": "208-686-1931",
            "fax_number": "208-686-5133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLEN",
        "first_name": "COY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2018-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "BF4836978",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-0589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ariel Nickole Davitt, BA
• Angela Dawn Delio, LCSW
• Ada M Denny, RN
• Thomas M Duyck, RPH
• Chase Albert Francoeur, OD
• Laura Gallaher, LCSW
• Evie L Gardipe
• Natasha Goddard
• Marilou Marcelo Gonzalez, M.D.
• Joy Katherine Goodwin, PA-C

• Family Medicine Physician in Plummer, ID
• Providers in Plummer, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; 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.