Individual provider Active NPI

Katherine Ann Fulco, CNP

  • Family Nurse Practitioner
  • Cumming, GA
National Provider Identifier
1922316405
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN-NP316853 Issued in GA
Practice address
3850 Windermere Pkwy Ste 105
Cumming, GA 30041-7033
Phone
(678) 455-2800
Fax
(770) 888-9998
NPI assigned
Sep 18, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 66369 WV
Family Nurse Practitioner 363LF0000X 71010054A IN
Family Nurse Practitioner 363LF0000X APRN-NP316853 GA Primary

Addresses

Primary practice location

3850 Windermere Pkwy Ste 105
Cumming, GA 30041-7033

Mailing address

3850 Windermere Pkwy Ste 105
Cumming, GA 30041-7033
Phone (678) 455-2800

Other identifiers 1

IdentifierTypeStateIssuer
300042114MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20230203002731 GA Practitioner - Nurse Practitioner 5294901781 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
West Virginia University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northside Primary Care Professional Services,LLCGroup PAC ID 9638343924, 313 clinicians

Practice addresses (Care Compare)

3850 Windermere Pkwy
Suite 105
Cumming, GA 30041-7002
Phone (678) 455-2800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN-NP316853GAMDFamily Nurse Practitioner
71010054AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Primary Care Professional Services, LLC CurrentSince Feb 1, 2023 Accepting new patients
Northside Primary Care Professional Services,LLC CurrentSince Feb 1, 2023 Accepting new patients

Locations

3850 Windermere Pkwy
Ste 105
Cumming, GA 30041
Phone (678) 455-2800

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

3350 Paddocks Pkwy
Suwanee, GA 30024
Phone (678) 474-9633

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1284768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760313600000",
    "number": "1922316405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 WINDERMERE PKWY STE 105",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417033",
            "telephone_number": "678-455-2800",
            "fax_number": "770-888-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 WINDERMERE PKWY STE 105",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417033",
            "telephone_number": "678-455-2800",
            "fax_number": "770-888-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULCO",
        "first_name": "KATHERINE",
        "middle_name": "ANN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-18",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "66369",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71010054A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "APRN-NP316853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300042114",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.