DR. FORREST WANE FULLENKAMP (NPI# 1730733007) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730733007 |
| Entity Type | Individual |
| Full Name | DR. FORREST WANE FULLENKAMP |
| Credential | DDS |
| Practice Address |
5330 Moseby St Columbia SC 29207 |
| Mailing Address |
4323 Hill St Columbia SC 29207-6022 |
| Practice Telephone | 7518033255 |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2019-07-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | 12013196A | IN | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | INDIANA PROFESSIONAL LICENSING AGENCY | 12013196A | 01 |
| Street Address |
5330 MOSEBY ST |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265043756 | Steven Mariani Rodriguez | Dentist | 5330 Moseby Street, Columbia, SC 29207 | 2020-08-10 |
| 1568082493 | Nichole Eckrich | Dentist | 5330 Moseby St., Columbia, SC 29207 | 2020-04-21 |
| 1306401625 | Kayla Anne Wolcott | Pharmacist | Moncrief Army Hospital Outpatient Pharmacy 1 Ft Jackson, Columbia, SC 29207 | 2019-05-02 |
| 1588145098 | Renetta Denise Green | Counselor | Fort Jackson/acs 9810 Lee St, Columbia, SC 29207 | 2018-08-23 |
| 1154814028 | Amanda Zelnick | Dentist | Bldg 5330 Moseby St, Ft Jackson, NC 29207 | 2018-06-14 |
| 1790231777 | Brittaney Elizabeth Anne Lewelling | Specialist/Technologist | 5975 Chesnut Road, Columbia, SC 29207 | 2016-08-30 |
| 1376749838 | Moncrief Army Community Hospital | Clinic/Center | 5330 Mosby Street, Fort Jackson, SC 29207 | 2007-06-22 |
| 1902002462 | Moncrief Army Community Hospital | Clinic/Center | 1890 Washington Road, Fort Jackson, SC 29207 | 2007-06-22 |
| 1730279860 | Donna L Briquet | Pharmacist | 4500 Marion Street, Columbia, SC 29207 | 2006-10-12 |
| 1235238411 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 4500, Stuart Street, Ft Jackson, SC 29207 | 2006-09-22 |
| Find all providers in zip 29207 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891313292 | Zachary Blake Riggs | Student in an Organized Health Care Education/Training Program | 2025 Gervais St Unit 321c, Columbia, SC 29204-1803 | 2020-07-12 |
| 1144848797 | Katrina Marie Linenko | Student in an Organized Health Care Education/Training Program | 1051 Southern Dr Unit 3707c, Columbia, SC 29201-5622 | 2020-07-10 |
| 1790303402 | Kaitlyn Michele Pierce | Student in an Organized Health Care Education/Training Program | 1051 Southern Dr Unit 1905c, Columbia, SC 29201-5607 | 2020-07-09 |
| 1316565211 | Erin Maureen Bryant | Student in an Organized Health Care Education/Training Program | 811 Polo Rd Apt 517, Columbia, SC 29223-4426 | 2020-07-08 |
| 1265050132 | Leona Joyce Keller | Student in an Organized Health Care Education/Training Program | 1051 Southern Dr Unit 901, Columbia, SC 29201-5194 | 2020-07-08 |
| 1922626720 | Brett William Elder | Student in an Organized Health Care Education/Training Program | 1051 Southern Dr Unit 3707, Columbia, SC 29201-5622 | 2020-07-08 |
| 1245858174 | Regina Duncan | Student in an Organized Health Care Education/Training Program | 1539 S Kilbourne Rd, Columbia, SC 29205-4708 | 2020-07-07 |
| 1972126043 | Sydney Allsbrook Funderburk | Student in an Organized Health Care Education/Training Program | 6401 Cloverdale Dr, Columbia, SC 29209-1840 | 2020-05-24 |
| 1841812591 | Chasitie Ann Mcintosh | Student in an Organized Health Care Education/Training Program | 1601 Greene Street Columbia South Carolina 29208, Columbia, SC 29208-0001 | 2020-05-15 |
| 1053933267 | Allyson Derrick | Student in an Organized Health Care Education/Training Program | 1601 Greene Street Columbia, Columbia, SC 29208-0001 | 2020-05-11 |
| Find all providers in COLUMBIA | ||||
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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.