Active NPI
Ericka K Fuller, CFNP
- Nurse Practitioner
- Erin, TN
National Provider Identifier
1912017435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- APN6883
- Practice address
- 4891 East Main St
Erin, TN 37061 - Phone
- (931) 289-4201
- Fax
- (931) 289-4204
- NPI assigned
- Aug 30, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APN6883 | TN | Primary |
Addresses
Primary practice location
4891 East Main St
Erin, TN 37061
Mailing address
P.O. Box 469
Erin, TN 37061
Phone (931) 289-4201
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3648764 | Medicaid | TN |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN6883 | TN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912017435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 469",
"city": "ERIN",
"state": "TN",
"postal_code": "37061",
"telephone_number": "931-289-4201",
"fax_number": "931-289-4204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4891 EAST MAIN ST",
"city": "ERIN",
"state": "TN",
"postal_code": "37061",
"telephone_number": "931-289-4201",
"fax_number": "931-289-4204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "ERICKA",
"middle_name": "K",
"name_prefix": "Miss",
"credential": "CFNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "TN",
"license": "APN6883",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3648764",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Erin, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.