Fulfilling Life PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

FULFILLING LIFE PLLC

Practice address

3 Club Centre CT Ste B1
Edwardsville, IL 62025-3519

Phone

(618) 699-4402

Fax

(618) 590-8199

NPI assigned

Apr 24, 2023

Organization subpart

No

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

Authorized official

Name

Di'Ara Woods, PA-C, CLCNPI 1497115497

Title

Ceo

Phone

(314) 749-8906

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Di'Ara Woods, PA-C

  • Physician Assistant
  • Edwardsville, IL
  • NPI 1497115497
  NPD Authorized official

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

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1922796408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 GLEN CARBON RD",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620342965",
            "telephone_number": "314-749-8906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 CLUB CENTRE CT STE B1",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253519",
            "telephone_number": "618-699-4402",
            "fax_number": "618-590-8199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULFILLING LIFE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-24",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "WOODS",
        "authorized_official_first_name": "DI'ARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-749-8906",
        "authorized_official_credential": "PA-C, CLC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reiley Lynn Friedly
• Briana Frierdich, MA, CCC-SLP
• Christine Elizabeth Frisbee, RBT
• Erica Frost, PHD, RN
• Clinton Troy Frye, D.C.
• Kaleena Galletta, FNP-C
• Janet L Gann, LCPC
• Tricia Lynn Garber, SLP
• Teresa Marie Garbett, RPH
• Teresa L Garrels, PT

• Specialist in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; 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.