DR. DONALD RAY FULSOM (NPI# 1679568794) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679568794 |
| Entity Type | Individual |
| Full Name | DR. DONALD RAY FULSOM |
| Credential | M.D. |
| Practice Address |
401 E Front St Tyler TX 75702-8213 |
| Practice Telephone | 9035936550 |
| Practice Fax Number | 9035936554 |
| Mailing Telephone | 9035936550 |
| Mailing Fax Number | 9035936554 |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2008-06-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
L6047 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 15804250 | 05 |
| Street Address |
401 E FRONT ST |
| City | TYLER |
| State | TX |
| Zip Code | 75702-8213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053935866 | Nicole Rene Wiggins | Occupational Therapist | 401 E Front St, Tyler, TX 75702-8213 | 2020-06-08 |
| 1174021430 | Sophia Lee Harkey | Massage Therapist | 401 E Front St, Tyler, TX 75702-8213 | 2018-01-31 |
| 1104297092 | Shanda Walker | Speech-Language Pathologist | 401 E Front St, Suite 123, Tyler, TX 75702-8213 | 2015-10-17 |
| 1972993640 | Candy Cares | In Home Supportive Care | 401 E Front St, Bldg 2 Suite 136, Tyler, TX 75702-8213 | 2015-02-02 |
| 1750625778 | Robert Lee | Occupational Therapist | 401 E Front St, Ste. 123, Tyler, TX 75702-8213 | 2012-11-15 |
| 1265739940 | S C Krause & Associates, LLC | Speech-Language Pathologist | 401 E Front St, Suite 123, Tyler, TX 75702-8213 | 2011-02-16 |
| 1063664670 | Tyler Speech Improvement Services | Speech-Language Pathologist | 401 E Front St, Suite 123, Tyler, TX 75702-8213 | 2008-10-14 |
| 1154578342 | Kathryn B. Akin, Md, Pa | Specialist | 401 E Front St, Tyler, TX 75702-8213 | 2008-08-19 |
| 1629193131 | Suzanne C Krause | Speech-Language Pathologist | 401 E Front St, Suite 123, Tyler, TX 75702-8213 | 2007-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679116610 | Tiffiney Mcmakin | Nurse Practitioner | 810 E Houston St # 100, Tyler, TX 75702 | 2019-10-22 |
| 1659852507 | Krystal Gayle Lilley | Licensed Vocational Nurse | 100 E Ferguson St Ste 60a, Tyler, TX 75702 | 2018-08-28 |
| 1679029383 | Cynthia Lynn Kalawe | Physical Therapist | 100 E Ferguson, Suite 1204, Tyler, TX 75702 | 2016-09-01 |
| 1649623646 | Susan E Oxford | Social Worker | 13495 Frankston Highway, Tyler, TX 75702 | 2016-07-14 |
| 1053769281 | All Kidz Kan | Home Health | 2902 E Front St, Tyler, TX 75702 | 2016-05-27 |
| 1821415639 | Heather Mullins | Physical Therapy Assistant | 100 E. Ferguson Ste.1204, Tyler, TX 75702 | 2014-03-19 |
| 1346671336 | Dennis Keith Johnson | Dentist | 3081 Hwy. 31 East, Tyler, TX 75702 | 2013-12-02 |
| 1275882201 | Bobby Gibson | Counselor | 401 East Front Street, Ste 233, Tyler, TX 75702 | 2012-09-06 |
| 1144596792 | Tina Marie Borke | Clinical Neuropsychologist | 719 West Front St., Tyler, TX 75702 | 2012-03-28 |
| 1457629529 | James Whaley Rapp | Specialist/Technologist | 430 South Beckham Avenue, Trinity Mother Frances Sports Medicine, Tyler, TX 75702 | 2011-12-05 |
| Find all providers in zip 75702 | ||||
| Taxonomy Code | 2084P0802X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Psychiatry |
| Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427666353 | Fresh Start Psychiatric Clinic | Psychiatry & Neurology | 9843 Blaine Lake Dr, Houston, TX 77086-2878 | 2020-07-16 |
| 1558776138 | Ivanshu Navinprakash Jain | Psychiatry & Neurology | Terrell State Hospital, 1200 E Brin St, Terrell, TX 75160 | 2014-06-23 |
| 1558592428 | Padmaja Puppala | Psychiatry & Neurology | 2116 Canyon Park Dr, Southlake, TX 76092 | 2009-07-27 |
| 1710143813 | Professional Medical Services | Psychiatry & Neurology | 35 Juniper Grove Pl, The Woodlands, TX 77382-4403 | 2008-07-29 |
| 1679609093 | Julie Ross Pittman | Psychiatry & Neurology | 3602 Matlock Rd Ste 210, Arlington, TX 76015-3600 | 2007-02-27 |
| 1033263009 | John R Marshall | Psychiatry & Neurology | 1107 N Cooper St, Arlington, TX 76011-5545 | 2007-01-23 |
| 1760536999 | Robert B Hunter | Psychiatry & Neurology | 2404 Kingston St, Houston, TX 77019-6604 | 2007-01-23 |
| 1487731758 | Beth Kratochvil Boyarsky | Psychiatry & Neurology | 711 N College St, Georgetown, TX 78626 | 2006-11-01 |
| 1801972385 | Robert Storey Wilson Sr. | Psychiatry & Neurology | 1100 N Mccart St, Stephenville, TX 76401-2430 | 2006-10-27 |
| 1427064062 | Luz Starck | Psychiatry & Neurology | 12050 Vance Jackson Building 2 Suite 201, San Antonio, TX 78230 | 2006-08-01 |
| Find all providers with the same taxonomy | ||||
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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.