FULCRUM CLINIC LLC (NPI# 1124512322) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124512322 |
| Entity Type | Organization |
| Organization Name | FULCRUM CLINIC LLC |
| Practice Address |
1025 Sw 4th St Ste 204 Moore OK 73160-2404 |
| Mailing Address |
2105 Cadwell Ave Oklahoma City OK 73170-3402 |
| Practice Telephone | 4057033090 |
| Practice Fax Number | 4057033095 |
| Mailing Telephone | 4054086005 |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2018-06-20 |
| Authorized Official Name | MARK G FERGESON (MANAGER) |
| Authorized Official Telephone | 4057033090 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
72566 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| INSURANCE | 1497170526 | 01 | |
| OK | 1497170526 | 05 |
| Street Address |
1025 SW 4TH ST STE 204 |
| City | MOORE |
| State | OK |
| Zip Code | 73160-2404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225678576 | Crystal Amanda Pitts | Student in an Organized Health Care Education/Training Program | 628 Allison Ln, Moore, OK 73160 | 2020-01-14 |
| 1982247623 | Tammie Lee Haworth | Occupational Therapy Assistant | Quest, 400 N Eastern Ave, Moore, OK 73160 | 2019-10-25 |
| 1477102580 | Php Management Group, LLC | Non-Pharmacy Dispensing Site | 1110 Magnolia Court, Moore, OK 73160 | 2019-09-11 |
| 1477117893 | Pharmology Moore LLC | Pharmacy | 1280 N Eastern Ave, Suite F, Moore, OK 73160 | 2019-05-01 |
| 1154891943 | Leah Cordell | Nurse Practitioner | 1280 North Eastern Ave., Suite F, Moore, OK 73160 | 2018-12-05 |
| 1467962332 | Healthcare Express, LLP | Clinic/Center | 551 Se 4th Street, Moore, OK 73160 | 2017-10-05 |
| 1306379557 | Dicarlo Venegas | Behavior Technician | 716 Wood Hollow Ln, Moore, OK 73160 | 2017-04-05 |
| 1073050167 | Tyron Dorrell Cosby Sr. | Case Manager/Care Coordinator | 1416 Penn Ln., Moore, OK 73160 | 2017-01-26 |
| 1326592650 | Kristin Kelley | Counselor | 1113 S Avery Dr, Moore, OK 73160 | 2016-08-03 |
| 1376912600 | Allison Kay Griffiths | Counselor | 9501 S. I-35 Service Rd, Apt 1504, Moore, OK 73160 | 2015-09-16 |
| Find all providers in zip 73160 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033729504 | Christopher R Stepp | Nurse Practitioner | 612 Madeline Ln, Moore, OK 73160-0003 | 2020-08-08 |
| 1821627167 | Lauren D'ann Clark | Nurse Practitioner | 3305 Red Maple Ln, Moore, OK 73170-1025 | 2020-04-08 |
| 1598324642 | Alexandria Nicole Martin | Nurse Practitioner | 705 Wall Cir, Moore, OK 73160-1940 | 2019-06-12 |
| 1518439991 | Alysia Mcdaniel | Nurse Practitioner | 9208 Winfield Ln, Moore, OK 73160-9161 | 2018-12-22 |
| 1154891943 | Leah Cordell | Nurse Practitioner | 1280 North Eastern Ave., Suite F, Moore, OK 73160 | 2018-12-05 |
| 1174034565 | Anthony Eugene Johnson | Nurse Practitioner | 905 Sw 38th St, Moore, OK 73160-9409 | 2017-10-12 |
| 1356892921 | Roy Slootheer | Nurse Practitioner | 1308 River Birch Run, Moore, OK 73160-1378 | 2016-10-19 |
| 1649639279 | Valerie Bell | Nurse Practitioner | 110 Kimberling Dr, Moore, OK 73160-4629 | 2016-02-10 |
| 1609281658 | Carol Leigh Hagan | Nurse Practitioner | 13316 S Western Ave Ste M, Moore, OK 73170-7310 | 2014-06-29 |
| 1508270588 | Cora Elizabeth Davis | Nurse Practitioner | 551 Se 4th St, Moore, OK 73160-6790 | 2014-06-17 |
| Find all providers in MOORE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.