Active NPI
Jennifer Fuller, L.M.T
- Specialist
- Kailua Kona, HI
National Provider Identifier
1952787046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 12913
- Practice address
- 75-5995 Kuakini Hwy Ste 603
Kailua Kona, HI 96740-2124 - Phone
- (808) 333-6404
- NPI assigned
- Jul 31, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 12913 | HI | Primary |
Addresses
Primary practice location
75-5995 Kuakini Hwy Ste 603
Kailua Kona, HI 96740-2124
Mailing address
81-902 Nape St
Kealakekua, HI 96750-8110
Phone (808) 333-6404
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12913 | HI | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438300800000",
"number": "1952787046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "81-902 NAPE ST",
"city": "KEALAKEKUA",
"state": "HI",
"postal_code": "967508110",
"telephone_number": "808-333-6404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75-5995 KUAKINI HWY STE 603",
"city": "KAILUA KONA",
"state": "HI",
"postal_code": "967402124",
"telephone_number": "808-333-6404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "JENNIFER",
"credential": "L.M.T",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-31",
"last_updated": "2015-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "HI",
"license": "12913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kailua Kona, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.